{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:37:16Z","timestamp":1760060236914,"version":"build-2065373602"},"reference-count":42,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Tissue expander (TE)-based breast reconstruction is a common procedure, but postoperative infection rates can reach up to 30%. The optimal skin antiseptic solution for minimizing these infections remains uncertain. This retrospective cohort study aimed to compare the impact of chlorhexidine and povidone-iodine for skin antisepsis in preventing surgical site infections in patients who underwent TE-based breast reconstruction. Methods: The TriNetX database was queried to identify patients who underwent TE-based breast reconstruction. Patients were classified into two cohorts: the chlorhexidine group and the povidone-iodine group. A propensity score matching analysis was performed to control infection risk factors. The primary outcome was the occurrence of surgical site infections, while secondary outcomes included wound dehiscence, emergency department visits, debridement, and TE removal. All outcomes were assessed at 30, 60, and 90 days following surgery. Results: After matching of both the chlorhexidine cohort and povidone-iodine cohort, each consisted of 1446 patients. Within 30 days post-surgery, no significant differences were observed between the chlorhexidine and povidone-iodine groups in terms of the risk of surgical site infections (RR 0.62, p = 0.168), wound dehiscence (RR 1.00, p = 1.000), emergency department visits (RR 0.95, p = 0.700), debridement (RR 0.71, p = 0.271), or TE removal (RR 0.84, p = 0.335). Similar results were seen at 60 and 90 days post-surgery. Conclusions: This study suggests that chlorhexidine and povidone-iodine may be equally effective for skin antisepsis in preventing surgical site infections and associated complications in patients undergoing TE-based breast reconstruction.<\/jats:p>","DOI":"10.3390\/jcm14165734","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T13:30:38Z","timestamp":1755091838000},"page":"5734","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chlorhexidine vs. Povidone for Skin Antisepsis in Tissue Expander-Based Breast Reconstruction: A Propensity Score-Matched Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8206-0448","authenticated-orcid":false,"given":"Agustin N.","family":"Posso","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audrey","family":"Mustoe","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7369-3981","authenticated-orcid":false,"given":"Manuela","family":"Neira","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micaela","family":"Tobin","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Yamin","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tricia","family":"Raquepo","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria J.","family":"Escobar-Domingo","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah J.","family":"Karinja","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5533-3166","authenticated-orcid":false,"given":"Bernard T.","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Viola, G.M., Selber, J.C., Crosby, M., Raad, I.I., Butler, C.E., Villa, M.T., Kronowitz, S.J., Clemens, M.W., Garvey, P., and Yang, W. (2016). Salvaging the Infected Breast Tissue Expander: A Standardized Multidisciplinary Approach. Plast. Reconstr. Surg. -Glob. Open, 4.","DOI":"10.1097\/GOX.0000000000000676"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1002\/jso.25500","article-title":"Classification of breast tissue expander infections: Back to the basics","volume":"120","author":"Kraenzlin","year":"2019","journal-title":"J. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"s7","DOI":"10.1089\/sur.2006.7.s1-7","article-title":"Risk Factors for Surgical Site Infection","volume":"7","author":"Cheadle","year":"2006","journal-title":"Surg. Infect."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1002\/aorn.13089","article-title":"Reducing the Risk of Surgical Site Infection with Effective Preoperative Patient Skin Antisepsis","volume":"112","author":"Spruce","year":"2020","journal-title":"AORN J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"A58","DOI":"10.1016\/j.ajic.2023.02.002","article-title":"Best products for skin antisepsis","volume":"51","author":"Boyce","year":"2023","journal-title":"Am. J. Infect. Control"},{"key":"ref_6","first-page":"405","article-title":"Chlorhexidine\u2013mechanism of action and its application to dentistry","volume":"70","author":"Barbara","year":"2017","journal-title":"J. Stomatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017","volume":"152","author":"Umscheid","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_8","unstructured":"World Health Organization (2025, May 26). Global Guidelines for the Prevention of Surgical Site Infection, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/27929621\/."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lepelletier, D., Maillard, J.Y., Pozzetto, B., and Simon, A. (2020). Povidone Iodine: Properties, Mechanisms of Action, and Role in Infection Control and Staphylococcus aureus Decolonization. Antimicrob. Agents Chemother., 64.","DOI":"10.1128\/AAC.00682-20"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.ijsu.2017.06.073","article-title":"Povidone iodine in wound healing: A review of current concepts and practices","volume":"44","author":"Bigliardi","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2069","DOI":"10.1016\/S0140-6736(15)00244-5","article-title":"Skin antisepsis with chlorhexidine\u2013alcohol versus povidone iodine\u2013alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): An open-label, multicentre, randomised, controlled, two-by-two factorial trial","volume":"386","author":"Mimoz","year":"2015","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1056\/NEJMoa0810988","article-title":"Chlorhexidine\u2013Alcohol versus Povidone\u2013Iodine for Surgical-Site Antisepsis","volume":"362","author":"Darouiche","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1001\/jama.2024.8531","article-title":"Povidone Iodine vs Chlorhexidine Gluconate in Alcohol for Preoperative Skin Antisepsis","volume":"332","author":"Widmer","year":"2024","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Zhang, Z., Kim, H.J., Lonjon, G., and Zhu, Y. (2019). Balance diagnostics after propensity score matching. Ann. Transl. Med., 7.","DOI":"10.21037\/atm.2018.12.10"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Nguyen, T.-L., Collins, G.S., Spence, J., Daur\u00e8s, J.-P., Devereaux, P.J., Landais, P., and Le Manach, Y. (2017). Double-adjustment in propensity score matching analysis: Choosing a threshold for considering residual imbalance. BMC Med. Res. Methodol., 17.","DOI":"10.1186\/s12874-017-0338-0"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1089\/jwh.2010.2391","article-title":"Chlorhexidine and Alcohol Versus Povidone-Iodine for Antisepsis in Gynecological Surgery","volume":"20","author":"Levin","year":"2011","journal-title":"J. Women\u2019s Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1089\/jop.2024.0141","article-title":"Chlorhexidine Compared with Povidone\u2013Iodine in Intravitreal Injection: A Systematic Review and Meta-Analysis","volume":"41","author":"Cruz","year":"2025","journal-title":"J. Ocul. Pharmacol. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Hsieh, H.-H., Yu, Y., Chang, C.-J., and Chang, T.-Y. (2025). A comparative meta-analysis of povidone\u2013iodine\u2013alcohol vs. chlorhexidine\u2013alcohol for preoperative skin antisepsis in abdominal surgery. Am. J. Surg., 244.","DOI":"10.1016\/j.amjsurg.2025.116318"},{"key":"ref_19","first-page":"S0883","article-title":"Chlorhexidine or Povidone-Iodine Solution Irrigation Versus Saline Irrigation for the Prevention of Postoperative Infections in Primary Total Joint Arthroplasty: A Systematic Review and Meta-Analysis","volume":"25","author":"Machinski","year":"2025","journal-title":"J. Arthroplast."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1016\/S0140-6736(21)01548-8","article-title":"Reducing surgical site infections in low-income and middle-income countries (FALCON): A pragmatic, multicentre, stratified, randomised controlled trial","volume":"398","author":"Ademuyiwa","year":"2021","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1001\/jamasurg.2020.1953","article-title":"Effect of Surgical Skin Antisepsis on Surgical Site Infections in Patients Undergoing Gynecological Laparoscopic Surgery","volume":"155","author":"Dior","year":"2020","journal-title":"JAMA Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1097\/JS9.0000000000002052","article-title":"Chlorhexidine gluconate versus povidone-iodine for nasal bacteria decolonization before transsphenoidal surgery in patients with pituitary neuroendocrine tumors: A prospective, randomized, double-blind, noninferiority trial","volume":"111","author":"Qian","year":"2025","journal-title":"Int. J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1089\/sur.2012.185","article-title":"A Retrospective Analysis of Surgical Site Infections after Chlorhexidine\u2013Alcohol versus Iodine\u2013Alcohol for Pre-Operative Antisepsis","volume":"15","author":"Charehbili","year":"2014","journal-title":"Surg. Infect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1002\/bjs.7214","article-title":"Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone\u2013iodine in clean-contaminated surgery","volume":"97","author":"Noorani","year":"2010","journal-title":"Br. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1007\/s00268-020-05384-7","article-title":"Preoperative Antisepsis with Chlorhexidine Versus Povidone-Iodine for the Prevention of Surgical Site Infection: A Systematic Review and Meta-analysis","volume":"44","author":"Chen","year":"2020","journal-title":"World J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.ajic.2016.09.017","article-title":"Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: A systematic review and meta-analysis","volume":"45","author":"Privitera","year":"2017","journal-title":"Am. J. Infect. Control"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1016\/S1473-3099(20)30738-6","article-title":"Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): An investigator-initiated, open-label, single centre, randomised-controlled, two-by-two factorial trial","volume":"21","author":"Guenezan","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wade, R.G., Bourke, G., Wormald, J.C.R., Totty, J.P., Stanley, G.H.M., Lewandowski, A., Rakhra, S.S., and Gardiner, M.D. (2021). Chlorhexidine versus povidone\u2013iodine skin antisepsis before upper limb surgery (CIPHUR): An international multicentre prospective cohort study. BJS Open, 5.","DOI":"10.1093\/bjsopen\/zrab117"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.1097\/BPO.0000000000001977","article-title":"Jumping on the Bandwagon: Comparing the Efficacy of Chlorhexidine Versus Povidone-Iodine Preoperative Skin Antiseptic in Preventing Surgical Site Infections Following Pediatric Orthopaedic Surgery","volume":"42","author":"Beber","year":"2022","journal-title":"J. Pediatr. Orthop."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"D\u00f6rfel, D., Maiwald, M., Daeschlein, G., M\u00fcller, G., Hudek, R., Assadian, O., Kampf, G., Kohlmann, T., Harnoss, J.C., and Kramer, A. (2021). Comparison of the antimicrobial efficacy of povidone-iodine-alcohol versus chlorhexidine-alcohol for surgical skin preparation on the aerobic and anaerobic skin flora of the shoulder region. Antimicrob. Resist. Infect. Control, 10.","DOI":"10.1186\/s13756-020-00874-8"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1086\/501620","article-title":"The Hospital Infection Control Practices Advisory Committee Guideline for Prevention of Surgical Site Infection, 1999","volume":"20","author":"Mangram","year":"1999","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"577","DOI":"10.4236\/ijcm.2013.412099","article-title":"Antimicrobial Assay of Chlorhexidine-Wetted Textile Napkins for Surgical Site Disinfection in Ocular Surgery","volume":"04","author":"Eslami","year":"2013","journal-title":"Int. J. Clin. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1007\/s12262-015-1252-5","article-title":"Are Breast Surgical Operations Clean or Clean Contaminated?","volume":"77","author":"Kataria","year":"2015","journal-title":"Indian J. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"858e","DOI":"10.1097\/PRS.0000000000008983","article-title":"Defining Mastectomy Skin Flap Necrosis: A Systematic Review of the Literature and a Call for Standardization","volume":"149","author":"Oleck","year":"2022","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"260","DOI":"10.25270\/wnds\/2021.260262","article-title":"Surgical Site Infection in Cancer Patients","volume":"33","author":"Bolton","year":"2021","journal-title":"Wounds A Compend. Clin. Res. Pract."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1017\/ice.2023.67","article-title":"Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update","volume":"44","author":"Calderwood","year":"2023","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Chin, K., W\u00e4rnberg, F., Kovacs, A., and Bagge, R.O. (2023). Impact of Surgical Care Bundle on Surgical Site Infection after Non-Reconstructive Breast Cancer Surgery: A Single-Centre Retrospective Comparative Cohort Study. Cancers, 15.","DOI":"10.3390\/cancers15030919"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1002\/aorn.14286","article-title":"Implementation of Bundled Interventions to Reduce Surgical Site Infections in Pediatric Patients Undergoing Cardiothoracic Surgery: A Quality Improvement Project","volume":"121","author":"Campbell","year":"2025","journal-title":"AORN J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.jamcollsurg.2018.10.002","article-title":"Evidence-Based Bundled Quality Improvement Intervention for Reducing Surgical Site Infection in Lower Extremity Vascular Bypass Procedures","volume":"228","author":"Hekman","year":"2019","journal-title":"J. Am. Coll. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1002\/ijgo.13257","article-title":"A bundled intervention lowers surgical site infection in hysterectomy for benign and malignant indications","volume":"150","author":"Guo","year":"2020","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Arroyo-Garcia, N., Badia, J.M., V\u00e1zquez, A., Pera, M., Par\u00e9s, D., Lim\u00f3n, E., Almendral, A., Piriz, M., D\u00edez, C., and Fraccalvieri, D. (2022). An interventional nationwide surveillance program lowers postoperative infection rates in elective colorectal surgery. A cohort study (2008\u20132019). Int. J. Surg., 102.","DOI":"10.1016\/j.ijsu.2022.106611"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Bogdan, R.-G., Helgiu, A., Cimpean, A.-M., Ichim, C., Todor, S.B., Iliescu-Glaja, M., Bodea, I.C., and Crainiceanu, Z.P. (2024). Assessing Fat Grafting in Breast Surgery: A Narrative Review of Evaluation Techniques. J. Clin. Med., 13.","DOI":"10.3390\/jcm13237209"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5734\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:26:44Z","timestamp":1760034404000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5734"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,13]]},"references-count":42,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14165734"],"URL":"https:\/\/doi.org\/10.3390\/jcm14165734","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,8,13]]}}}