Subject(s)
Breast Implantation , Breast Implants , Breast Neoplasms , Esthetics , Humans , Hypochlorous AcidABSTRACT
Background: Hypochlorous acid (HOCl) demonstrates rapid and broad antimicrobial activity against planktonic and biofilm phenotype bacteria in vitro. Objectives: To identify the protein content present in breast pockets in vivo and calculate the estimated active concentration of HOCl, (PhaseOne, Integrated Healing Technologies, Franklin, TN) following HOCl-protein interactions. Methods: Fluid samples were collected prior to implant insertion in 18 consecutive patients, representing 36 pocket samples, with all cases being bilateral primary breast augmentations. Samples were evaluated by an independent CLIA approved laboratory for albumin and total protein concentration in g/dL. Results were compared to HOCl solution concentration and protein binding potential to determine availability of free HOCl. Results: The mean tissue sample concentration (right and left breast) was 31.6 mg/dL which translates to 0.0001 mmol per 20 cc of interstitial fluid. Mean total protein levels (right and left breast) were 62.3 mg/dL or 0.000187 mmol per 20 cc interstitial fluid. Based upon potential stoichiometric neutralization of HOCl by proteins in either a 1:1 or 3:1 ratio, using 115 cc of HOCl solution (per breast) at a concentration of 250 ppm/mL or 0.025% HOCl or = 0.48 mmol HOCl/dL, there would be 2950 times the amount of active HOCl at a 1:1 reaction ratio, or 983 times more HOCl assuming a 3:1 reaction ratio. Based on the range of identified levels of protein in individual surgical pockets in the study, there is an estimated 242 to 12,500 times more HOCl molecules than protein at a 3:1 molar ratio of binding or reactive protein. Conclusions: n estimated range of 983-2950 times more HOCl molecules are present during irrigation with 230 cc of PhaseOne® (115 cc for each breast) than available protein. This supports the antimicrobial and anti-biofilm activity as described in previous in vitro studies when using PhaseOne® as part of pocket irrigation.
Subject(s)
Anti-Infective Agents/administration & dosage , Bacteria/drug effects , Breast Implantation/adverse effects , Hypochlorous Acid/administration & dosage , Surgical Wound Infection/prevention & control , Adult , Albumins/analysis , Bacteria/metabolism , Biofilms/drug effects , Breast/microbiology , Breast/surgery , Breast Implantation/methods , Endotoxins/analysis , Endotoxins/metabolism , Exotoxins/analysis , Exotoxins/metabolism , Female , Humans , Intraoperative Care/methods , Middle Aged , Proteomics , Surgical Wound Infection/microbiologyABSTRACT
The use of ultrasound-assisted lipoplasty (UAL) to assist in the removal of subcutaneous fat has been practiced in Europe for nearly 15 years and over the last 7 years has gained popularity in the United States. Liposuction is now one of the most commonly performed cosmetic procedures by board-certified plastic surgeons. This article will review the UAL procedure, its history, regulatory issues, instrumentation and equipment needed. It will also review changes and recent updates, clinical protocol, complications, and future considerations.
