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Stein MJ, Weissman JP, Harrast J, Rubin JP, Gosain AK, Matarasso A. Clinical Practice Patterns in Abdominoplasty: 16-Year Analysis of Continuous Certification Data from the American Board of Plastic Surgery. Plast Reconstr Surg 2024; 153:66-74. [PMID: 37010463 DOI: 10.1097/prs.0000000000010500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND The authors evaluated trends in practice patterns for abdominoplasty based on a 16-year review of tracer data collected by the American Board of Plastic Surgery as part of the continuous certification process. METHODS To facilitate comparison of an equal number of patients over time, tracer data from 2005 to 2021 were split into an early cohort (EC) (from 2005 to 2014) and a recent cohort (RC) (from 2015 to 2021). Fisher exact tests and two-sample t tests were used to compare patient demographics, surgical techniques, and complication rates. RESULTS Data from 8990 abdominoplasties (EC, n = 4740; RC, n = 4250) were analyzed. RC abdominoplasties report a lower rate of complications (RC, 19%; EC, 22%; P < 0.001) and a lower rate of revision surgery (RC 8%; EC, 10%; P < 0.001). This has occurred despite the increased use of abdominal flap liposuction (RC, 25%; EC, 18%; P < 0.001). There has been a decline in the use of wide undermining (81% versus 75%; P < 0.001), vertical plication of the abdomen (89% versus 86%; P < 0.001), and surgical drains (93% versus 89%; P < 0.001). Abdominoplasty surgery is increasingly performed in an outpatient setting, with increased use of chemoprophylaxis for thrombosis prevention. CONCLUSIONS Analysis of these American Board of Plastic Surgery tracer data highlights important trends in clinical practice over the past 16 years. Abdominoplasty continues to be a safe and effective procedure with similar complication and revision rates over the 16-year period.
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Affiliation(s)
- Michael J Stein
- From the Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital
| | - Joshua P Weissman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg, School of Medicine
| | | | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh
| | - Arun K Gosain
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg, School of Medicine
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital
| | - Alan Matarasso
- From the Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital
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Klifto KM, Rydz AC, Biswas S, Hultman CS, Erdmann D, Phillips BT. Evidence-Based Medicine: Systemic Perioperative Antibiotic Prophylaxis for Prevention of Surgical-Site Infections in Plastic and Reconstructive Surgery. Plast Reconstr Surg 2023; 152:1154e-1182e. [PMID: 37141459 DOI: 10.1097/prs.0000000000010608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND After nearly a decade of new data, the Evidence-Based Consensus Conference Statement from the American Association of Plastic Surgeons was updated for prophylactic systemic antibiotics to prevent surgical-site infections (SSI). Pharmacotherapeutic concepts using antimicrobial stewardship were applied for clinical interpretation and management to optimize patient outcomes and minimize resistance. METHODS PRISMA, Cochrane, and GRADE certainty of evidence guidelines were implemented for the structure and synthesis of the review. PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were systematically and independently searched for randomized controlled trials (RCTs). The authors included patients who had plastic and reconstructive surgery and were treated with prophylactic systemic antibiotics administered perioperatively (preoperatively, intraoperatively, or postoperatively). Comparisons were made between active interventions and nonactive interventions (placebo) at different prespecified durations to determine the development of an SSI. Meta-analyses were performed. RESULTS The authors included 138 RCTs that met eligibility criteria. RCTs consisted of 18 breast, 10 cosmetic, 21 hand/peripheral nerve, 61 pediatric/craniofacial, and 41 reconstructive studies. The authors examined bacterial data extracted from studies for patients who did or did not take prophylactic systemic antibiotics for prevention of SSI. Clinical recommendations were provided using level I evidence. CONCLUSIONS Surgeons have long been overprescribing systemic antibiotic prophylaxis in plastic and reconstructive surgery. Evidence supports antibiotic prophylaxis to prevent SSI for specific indications and durations. Prolonged antibiotic use has not been linked to reductions in SSIs, and misuse may increase the bacterial diversity of infections. Greater efforts should focus on transitioning from practice-based to pharmacotherapeutic evidence-based medicine. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Kevin M Klifto
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
| | | | - Sonali Biswas
- Division of Plastic and Reconstructive Surgery, University of Michigan School of Medicine
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Detlev Erdmann
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University School of Medicine
| | - Brett T Phillips
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University School of Medicine
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3
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Homsy P, Romo I, Kauhanen S. Antibiotic prophylaxis in clean and clean-contaminated plastic surgery: A critical review. J Plast Reconstr Aesthet Surg 2023; 83:233-245. [PMID: 37285776 DOI: 10.1016/j.bjps.2023.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 06/09/2023]
Abstract
Antibiotic prophylaxis is frequently used in plastic surgery procedures, despite the generally low rates of infection and few guidelines on the practice. The increasing prevalence of bacterial resistance to antibiotics calls for a reduction in unnecessary antibiotic use. The aim of this review was to create an updated summary of the available data on the effectiveness of antibiotic prophylaxis in reducing the postoperative infection in clean and clean-contaminated plastic surgery. A systematic literature search was performed on the databases Medline, Web of Science, and Scopus, limited to articles published January 2000 onward. Randomized controlled trials (RCTs) were included in the primary review, whereas older RCTs and other studies were sought if 2 or fewer relevant RCTs were identified. Overall, 28 relevant RCTs, 2 nonrandomized trials, and 15 cohort studies were identified. Although the number of studies for each type of surgery is limited, the data suggest that prophylactic systemic antibiotic may be unnecessary in noncontaminated facial plastic surgery, reduction mammaplasty, and breast augmentation. In addition, no benefit is apparent from extending the antibiotic prophylaxis over 24 h in rhinoplasty, aerodigestive tract reconstruction, and breast reconstruction. No studies assessing the necessity of antibiotic prophylaxis in abdominoplasty, lipotransfer, soft tissue tumor surgery, or gender affirmation surgery were identified. In conclusion, limited data are available on the effectiveness of antibiotic prophylaxis in clean and clean-contaminated plastic surgery. More studies on this topic are needed before strong recommendations can be made on the use of antibiotics in this setting.
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Affiliation(s)
- Pauliina Homsy
- Department of Plastic Surgery, Puistosairaala, University of Helsinki and Helsinki University Central Hospital, P.O. Box 281, 00029 HUS, Finland.
| | - Inka Romo
- Department of Infectious Diseases, Meilahden Kolmiosairaala, University of Helsinki and Helsinki University Central Hospital, P.O. Box 372, 00029 HUS, Finland
| | - Susanna Kauhanen
- Department of Plastic Surgery, Puistosairaala, University of Helsinki and Helsinki University Central Hospital, P.O. Box 281, 00029 HUS, Finland
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Weber J, Kalash Z, Simunovic F, Bonaventura B. Prolonged postoperative antibiotic administration reduces complications after medial thigh lift. J Plast Surg Hand Surg 2022; 56:361-368. [PMID: 34928776 DOI: 10.1080/2000656x.2021.2010738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is widespread consensus that there is no indication for postoperative antibiotic administration after elective surgery. However, medial thigh lift (MTL) remains a procedure with a notoriously high rate of wound-healing disorders and infections. This study investigates the correlation between prolonged antibiotic administration and complications after MTL in massive weight loss patients. We performed a single-institution retrospective review of 121 patients undergoing MTL between 2009 and 2020. Data on postoperative outcome, demography, surgery and comorbidities were collected. All patients received intravenous antibiotics preoperatively. One group was continued on oral antibiotics for two weeks postoperatively. Complications and surgical site infections were observed and evaluated. There was no difference between the groups regarding age, BMI, or presence of obesity-associated risk factors. We observed complications in 76 patients (71%), with 60 (56%) minor and 16 (15%) major complications. The group without prolonged antibiotic administration had a higher number of total complications (OR 3.5; p = 0.0037), major complications (OR 4; p = 0.01), and wound infections (OR 6.8; p = 0.0004). Logistical regression analysis showed that this effect was independent of type of weight loss, resection volume, and age. Reduction of major infections by prolonged antibiotics was, however, dependent on BMI Δ. No side-effects associated with antibiotics were registered in this series. This study suggests that prolonged antibiotic administration may decrease complications in MTL. We thus continue to use prolonged antibiotic administration after MTL. Further research is needed to determine the optimal duration of antibiotic treatment. Level of Evidence: Level IV: therapeutic study.
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Affiliation(s)
- J Weber
- Department of Plastic and Hand Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Z Kalash
- Department of Plastic and Hand Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - F Simunovic
- Department of Plastic and Hand Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - B Bonaventura
- Department of Plastic and Hand Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
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ElHawary H, Hintermayer MA, Alam P, Brunetti VC, Janis JE. Decreasing Surgical Site Infections in Plastic Surgery: A Systematic Review and Meta-analysis of Level 1 Evidence. Aesthet Surg J 2021; 41:NP948-NP958. [PMID: 33693462 DOI: 10.1093/asj/sjab119] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although many interventions are implemented to prevent surgical site infections (SSIs) in plastic surgery, their supporting evidence is inconsistent. OBJECTIVES The goal of this study was to assess the efficacy of methods for decreasing SSIs in plastic surgery. METHODS A systematic review and meta-analysis were performed to compare the effects of SSI prevention methods. All the studies were assessed for quality of evidence according to the GRADE assessment. RESULTS Fifty Level 1 randomized controlled trials were included. The most common interventions for preventing SSIs were antibiotic prophylaxis, showering, prepping, draping, and the use of dressings. Current evidence suggests that antibiotic prophylaxis is largely unnecessary and overused in many plastic surgical procedures, with the exception of head and neck oncologic, oral craniofacial, and traumatic hand surgeries. CONCLUSIONS Efficacy of antibiotic prophylaxis in plastic surgery is dependent on surgery type. There is a lack evidence that showering and prepping with chlorohexidine and povidone reduces SSIs. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Hassan ElHawary
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | | | - Peter Alam
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | | | - Jeffrey E Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
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Mankowski P, Cherukupalli A, Slater K, Carr N. Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence. Plast Surg (Oakv) 2021; 29:132-138. [PMID: 34026678 PMCID: PMC8120557 DOI: 10.1177/2292550321997005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. In doing so, we aim to determine risk factors for antibiotic overprescribing in the context of surgical prophylaxis. Methods: A literature review identifying EBG for antibiotic prophylaxis use during common plastic surgery procedures was performed. Concurrently, a provincial survey of plastic surgery residents, fellows, academic and community plastic surgeons was used to identify their antibiotic prophylaxis prescribing practices. These findings were then compared to recommendations identified from our review. The compliance of the provincial plastic surgery community with current EBG was determined for 38 surgical scenarios to identify which clinical factors and procedure types were associated with unsupported antibiotic use. Results: Within the literature, 31 of the 38 categories of surveyed plastic surgery operations have EBG for use of prophylactic antibiotics. When surgical procedures have EBG, 19.5% of plastic surgery trainees and 21.9% of practicing plastic surgeons followed recommended prophylaxis use. Average adherence to EBG was 59.1% for hand procedures, 24.1% for breast procedures, and 23.9% for craniofacial procedures. Breast reconstruction procedures and contaminated craniofacial procedures were associated with a significant reduction in adherence to EBG resulting in excessive antibiotic use. Conclusion: Even when evidence-based recommendations for antibiotic prophylaxis exist, plastic surgeons demonstrate variable compliance based on their reported prescribing practices. Surgical procedures with low EBG compliance may reflect risk avoidant behaviors in practicing surgeons and highlight the importance of improving education on the benefits of antibiotic prophylaxis in these clinical situations.
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Affiliation(s)
- Peter Mankowski
- Division of Plastic Surgery, University of British Columbia, Vancouver British Columbia, Canada
| | - Abhiram Cherukupalli
- Faculty of Medicine, University of British Columbia, Vancouver British Columbia, Canada
| | - Karen Slater
- Faculty of Medicine, University of British Columbia, Vancouver British Columbia, Canada
| | - Nick Carr
- Faculty of Medicine, University of British Columbia, Vancouver British Columbia, Canada
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Fiorentini C, Bedini A, Mandel VD, Bacca E, Menozzi M, Reggiani C, De Pace B, Meschiari M, Santoro A, Franceschini E, Mussini C, Terrenato I, Giacomelli L, Magnoni C. Comparison of two perioperative antibiotic schedules in patients undergoing surgical reconstruction with dermal matrix after excision of skin cancer. Int Wound J 2020; 17:937-943. [PMID: 32232964 PMCID: PMC7948944 DOI: 10.1111/iwj.13354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/30/2022] Open
Abstract
Perioperative antibiotic treatment duration in skin reconstruction with dermal substitutes is not well established. This study compares the incidence of infective complications after two different durations of perioperative antibiotic treatment in patients undergoing surgical reconstruction with skin dermal substitutes (SDS) after excision of skin cancer. Infective complications at the site of SDS were compared in subjects undergoing surgical reconstruction who received either a > 24-hour (extended protocol) or a ≤ 24-hour (short protocol) perioperative antibiotic treatment. Of 116 patients undergoing SDS surgical reconstruction, 62 (53.4%) received an extended schedule, and 54 (46.6%) received a short schedule. The two groups were similar for gender, age, comorbidities, American Society of Anesthesiologists score, and type of skin cancer. Overall incidence rate of infection was 20.7% (24/116). No differences in terms of risk of infection were observed between the two groups (OR: 1.04, 95% CI: 0.42-2.55; P = .937). Patients undergoing SDS reconstruction in the limb/foot had a higher risk of infection in comparison with those undergoing SDS reconstruction in the chest/head (OR: 2.69, 95% CI: 1.06-6.86; P = .038). The short protocol was demonstrated to be beneficial to patients undergoing surgical reconstruction with SDS. A ≤ 24-hour perioperative antibiotic schedule did not increase the infection rate, potentially allowing a reduction of antibiotic exposure.
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Affiliation(s)
- Chiara Fiorentini
- Department of DermatologyUniversity of Modena and Reggio EmiliaModenaItaly
| | - Andrea Bedini
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | | | - Erica Bacca
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | - Marianna Menozzi
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | - Camilla Reggiani
- Department of DermatologyUniversity of Modena and Reggio EmiliaModenaItaly
| | - Barbara De Pace
- Department of DermatologyUniversity of Modena and Reggio EmiliaModenaItaly
| | - Marianna Meschiari
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | - Antonella Santoro
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | - Erica Franceschini
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | - Cristina Mussini
- Department of Infectious DiseasesAzienda Ospedaliero‐Universitaria “Policlinico of Modena”ModenaItaly
| | - Irene Terrenato
- Biostatistics‐Scientific DirectionIRCCS Regina Elena National Cancer InstituteRomeItaly
| | - Luca Giacomelli
- Department of Surgical Sciences and Integrated DiagnosticsUniversity of GenoaGenoaItaly
- Polistudium srlMilanoItaly
| | - Cristina Magnoni
- Department of DermatologyUniversity of Modena and Reggio EmiliaModenaItaly
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8
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Wiser I, Plonski L, Shimon N, Friedman T, Heller L. Surgical Site Infection Risk Factor Analysis in Postbariatric Patients Undergoing Body Contouring Surgery: A Nested Case-Control Study. Ann Plast Surg 2020; 82:493-498. [PMID: 30950874 DOI: 10.1097/sap.0000000000001819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) following body-contouring plastic surgery pose a significant burden on patients and caregivers, possibly leading to undesired surgical outcomes. Surgical site infection incidence following body-contouring plastic surgery ranges from 2% to 7%, but is estimated much higher among postbariatric massive weight loss (MWL) patients. OBJECTIVE The aim of this study was to evaluate SSI rate, risk and protective factors among postbariatric MWL patients following body-contouring plastic surgery. METHODS This was a nested case-control study of MWL patients who underwent body-contouring plastic surgery at the Department of Plastic Surgery at Assaf Harofeh Medical Center, between 2007 and 2014. Data were obtained from medical records. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Logistic regression was conducted to assess independent risk factors for SSIs. RESULTS From a cohort of 172 patients, 86 were included in the study. Surgical site infection rate was 20% (n = 17). Significant SSI risk factors included lifetime maximal weight and lifetime maximal body mass index (P = 0.039 and P = 0.002, respectively), body mass index loss prior to surgery (P = 0.032), estimated blood loss during surgery (P = 0.002), and gynecomastia repair procedure (P = 0.038). Independent SSI-associated factors included thigh lift procedure (odds ratio, 4.66; 95% confidence interval, 1.13-19.28) and preoperative antimicrobial prophylaxis (odds ratio, 0.04; 95% confidence interval, 0.03-0.61). CONCLUSIONS Although not required by current guidelines for body-contouring plastic surgery, preoperative antimicrobial prophylaxis in our study demonstrated a significant protective effect against SSIs. Further research may reveal its true contribution to SSI prevention in body-contouring plastic surgery.
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Affiliation(s)
| | - Lori Plonski
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
| | - Nitai Shimon
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
| | - Tali Friedman
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
| | - Lior Heller
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
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10
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Kaoutzanis C, Ganesh Kumar N, Winocour J, Hood K, Higdon KK. Surgical Site Infections in Aesthetic Surgery. Aesthet Surg J 2019; 39:1118-1138. [PMID: 30892625 DOI: 10.1093/asj/sjz089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Surgical site infections represent one of the most common postoperative complications in patients undergoing aesthetic surgery. As with other postoperative complications, the incidence of these infections may be influenced by many factors and varies depending on the specific operation performed. Understanding the risk factors for infection development is critical because careful patient selection and appropriate perioperative counseling will set the right expectations and can ultimately improve patient outcomes and satisfaction. Various perioperative prevention measures may also be employed to minimize the incidence of these infections. Once the infection occurs, prompt diagnosis will allow management of the infection and any associated complications in a timely manner to ensure patient safety, optimize the postoperative course, and avoid long-term sequelae.
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Affiliation(s)
| | - Nishant Ganesh Kumar
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Julian Winocour
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN
| | - Keith Hood
- Department of Surgery, Division of Plastic Surgery, Rush University Medical Center, Chicago, IL
| | - K Kye Higdon
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN
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11
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Shestak KC, Rios L, Pollock TA, Aly A. Evidenced-Based Approach to Abdominoplasty Update. Aesthet Surg J 2019; 39:628-642. [PMID: 30481261 DOI: 10.1093/asj/sjy215] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The following publication was compiled as an evidence-based update for plastic surgeons performing abdominoplasty from a review of the published literature on that subject between January 2014 and February 2017. It is an overview of various aspects of abdominoplasty including preoperative patient assessment, variations and advances in both surgical and anesthetic technique, patient safety, and outcomes. It is intended to serve as an adjunct to previously published evidence-based reviews of abdominoplasty.
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Affiliation(s)
- Kenneth C Shestak
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
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12
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Guo T, Chen B, Rao F, Wu P, Liu P, Liu Z, Li Z. Identifying the superior antibiotic prophylaxis strategy for breast surgery: A network meta-analysis. Medicine (Baltimore) 2019; 98:e15405. [PMID: 31027139 PMCID: PMC6831324 DOI: 10.1097/md.0000000000015405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The clinical roles of different antibiotic prophylaxis strategies for breast surgery remains large unknowns. The aim of this study is to evaluate different antibiotic prophylaxis strategies based on a network meta-analysis. METHODS We initially retrieved literature from globally recognized databases, namely, MEDLINE, EMBASE and Cochrane Central, to address relative randomized controlled trials (RCTs) investigating the antibiotic prophylaxis strategies for breast surgery. Relative postoperative infection rates were quantitatively pooled and estimated based on the Bayesian theorem. Values of surface under the cumulative ranking curve (SUCRA) probabilities were calculated and ranked. Additional pairwise meta-analyses were performed to validate differences between the respective strategies at the statistical level for further explanations. RESULTS After a detailed review, a total of 14 RCTs containing 6 different strategies were included for the network meta-analysis. The results indicated that the application of antibiotics administered during pre- plus post- plus intraoperative periods possessed the highest possibility of having the best clinical effects (SUCRA, 0.40), followed by intraoperative administration alone (SUCRA, 0.35) and pre- plus intraoperative administrations (SUCRA, 0.20). Moreover, an additional pairwise meta-analysis determined that pre- and intraoperative-related strategies significantly reduced postoperative infections at a statistical level. CONCLUSION Based on the current evidence, we concluded that application of antibiotics administered during pre- plus post- plus intraoperative periods seemed to reveal superior benefits. However, the essential roles of pure intraoperative and postoperative application were still need to be further validated.
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Affiliation(s)
- Tao Guo
- Department of Hepatobiliary and Pancreatic Surgery, and Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Baiyang Chen
- Department of Hepatobiliary and Pancreatic Surgery, and Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Fengying Rao
- School of Nursing, Huanggang Polytechnic College, Huanggang, P.R. China
| | - Ping Wu
- Department of Hepatobiliary and Pancreatic Surgery, and Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Pengpeng Liu
- Department of Hepatobiliary and Pancreatic Surgery, and Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Zhisu Liu
- Department of Hepatobiliary and Pancreatic Surgery, and Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Zhen Li
- Department of Hepatobiliary and Pancreatic Surgery, and Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
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A preoperative cotininury test for abdominoplasty reduces peri-operative complications. ANN CHIR PLAST ESTH 2018; 63:307-315. [PMID: 29778249 DOI: 10.1016/j.anplas.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/15/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Smoking induces complications in plastic surgery, in particular wound healing delays. Despite a 4-weeks' abstinence asking before and after surgery, some patients denied or hid their consumption. The aim of this study was to evaluate the effectiveness of a cotininury detection test in terms of improvement in outcomes after an abdominoplasty. MATERIAL AND METHODS This retrospective cohort study included patients who underwent an abdominoplasty with umbilical transposition and lipoaspiration. Current smokers were asked to stop smoking 4 weeks before and after surgery. After 2013, we performed a preoperative cotininury test for patients having abdominoplasty, with a cancellation of surgery in case of positive result. We analyzed the test's effectiveness on delayed healing and on other complications. RESULTS Two hundred and thirty-five patients were included; 80 were tested and 21,3% had a positive test. There was significantly less delayed healing in the "screening" group than in the "no screening": 20,3% versus 41,5% (P=0,002). Alike, complications were significantly less frequent in the "screening" group than in the "no screening": 18,1% versus 42,3% (P<0,001). CONCLUSION The routine use of the cotininury test in preoperative abdominoplasties significantly reduces risk of delayed healing and other serious complications. It is an objective test, which is simple, quick and non-invasive. Smoking cessation must be at least 4 weeks before and after the surgery. Following medical advice to cease smoking by the surgeon and anesthetist, referral to an appropriate tobacco-addiction specialist clinic may be helpful for the patient who has difficulty stopping smoking.
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14
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Managing Complications in Abdominoplasty: A Literature Review. Arch Plast Surg 2017; 44:457-468. [PMID: 28946731 PMCID: PMC5621815 DOI: 10.5999/aps.2017.44.5.457] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/01/2017] [Accepted: 06/13/2017] [Indexed: 11/08/2022] Open
Abstract
Background Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them. Methods A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH) terms, and references were scanned for further relevant articles. Results According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death. Conclusions The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results.
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Circumferential Contouring of the Lower Trunk: Indications, Operative Techniques, and Outcomes-A Systematic Review. Aesthetic Plast Surg 2016; 40:652-68. [PMID: 27286851 DOI: 10.1007/s00266-016-0660-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/25/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increasing obesity prevalence and development of bariatric surgery have led to the development of skin re-draping techniques. Several contouring techniques have been described for treating the circumferential excess of the lower trunk. MATERIALS AND METHODS We performed a systematic review to summarize surgical indications, operative techniques, peri-operative management (nutritional supplementation, antibiotic prophylaxis, thrombo-prophylaxis), outcomes, complications, patient satisfaction, and impact on quality of life of circumferential contouring of the lower trunk procedures. A systematic review, based on the PRISMA criteria, was conducted using the Pubmed and Cochrane databases. RESULTS The review included 42 articles and 1748 operated patients. Two studies only were graded as level of evidence II; the others were graded as levels III to V. The most frequently reported indication was massive weight loss. All the described techniques derived either from belt lipectomy or lower bodylift. Belt lipectomy resulted in a posterior scar situated at the waistline and allowed a better correction of hip back rolls, whereas lower bodylift was more effective on buttock and lateral thigh ptosis. The most reported complication was wound dehiscence. Patient satisfaction and quality of life scores were high in all studies. CONCLUSIONS This review included a majority of low-level evidence studies that limit extrapolability of the results. Future randomized prospective studies may generate stronger evidence, with a standardization of surgical indications and operative techniques. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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16
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A Randomized Prospective Study of Prophylactic Cloxacillin in Breast Reduction Surgery. Ann Plast Surg 2015; 74:17-21. [DOI: 10.1097/sap.0000000000000352] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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A review of prophylactic antibiotics use in plastic surgery in China and a systematic review. Int J Surg 2014; 12:1300-5. [DOI: 10.1016/j.ijsu.2014.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 08/27/2014] [Accepted: 10/25/2014] [Indexed: 01/24/2023]
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18
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Hunter JG. Commentary on: effectiveness of prophylactic antibiotics in outpatient plastic surgery. Aesthet Surg J 2014; 34:1259-60. [PMID: 25301792 DOI: 10.1177/1090820x14535802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John G Hunter
- Dr Hunter is an Associate Attending Plastic Surgeon, New York-Presbyterian Hospital (Weill Cornell Campus), New York, New York, and Vice Chairman, Department of Surgery, and Chief of Plastic Surgery, New York Methodist Hospital, Brooklyn, New York
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Rangaswamy M. Minimising complications in abdominoplasty: An approach based on the root cause analysis and focused preventive steps. Indian J Plast Surg 2014; 46:365-76. [PMID: 24501473 PMCID: PMC3901918 DOI: 10.4103/0970-0358.118615] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Significant complications still occur after abdominoplasty, the rate varies widely in different series. This variation suggests that there is a lot of scope for improvement. This paper reviews the various complications and also the technical improvements reported in the last 20 years. The root cause of each complication is analysed and preventive steps are suggested based on the literature and the author's own personal series with very low complication rates. Proper case selection, risk stratified prophylaxis of thromboembolism, initial synchronous liposuction, flap elevation at the Scarpa fascia level, discontinuous incremental flap dissection, vascular preservation and obliteration of the sub-flap space by multiple sutures emerge as the strongest preventive factors. It is proposed that most of the complications of abdominoplasty are preventable and that it is possible to greatly enhance the aesthetic and safety profile of this surgery.
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Affiliation(s)
- Mohan Rangaswamy
- Plastic Surgery Department, American Academy of Cosmetic Surgery Hospital, Dubai Healthcare City, Dubai, U.A.E
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21
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Delaunay F, Pegot A, Coquerel-Beghin D, Aktouf A, Auquit-Auckbur I. Fasciites nécrosantes à Staphylococcus lugdunensis après dermolipectomie abdominale : à propos de deux cas et revue de la littérature. ANN CHIR PLAST ESTH 2014; 59:136-9. [DOI: 10.1016/j.anplas.2013.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/10/2013] [Indexed: 11/29/2022]
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22
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 705] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Toia F, D’Arpa S, Massenti MF, Amodio E, Pirrello R, Moschella F. Perioperative antibiotic prophylaxis in plastic surgery: A prospective study of 1100 adult patients. J Plast Reconstr Aesthet Surg 2012; 65:601-9. [DOI: 10.1016/j.bjps.2011.11.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 09/09/2011] [Accepted: 11/10/2011] [Indexed: 10/14/2022]
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25
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Abstract
Indications for most forms of abdominoplasty are slight weight fluctuations or pregnancy. The steadily increasing number of patients with greater weight loss as well as the growing number of bariatric operations subsequently leads to a significant increase in body contouring procedures and places new challenges on plastic surgeons. After major weight loss patients present with extremely variable deformities in the lower and upper trunk as well as the extremities, which have to be treated individually with an appropriate procedure. The restoration of the lower trunk presents the first stage of the entire reconstruction process. The various modifications of abdominoplasty procedures with their various incision patterns and scar courses and the circumferential lower trunk dermatolipectomy represent advanced operations for every individual case. Plastic surgeons should be fully aware of differences and indications of every available procedure in the area of the lower trunk and should have the ability to offer the entire repertory for each individual deformity. A high postoperative patient satisfaction results from a customized procedure selection, the optimal implementation with a correspondingly low rate of complications and above-average patient care.
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Affiliation(s)
- D F Richter
- Klinik für Plastische Chirurgie, Dreifaltigkeits-Krankenhaus, Wesseling, Deutschland.
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27
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Abstract
Improvements in infection prevention practices over the past several decades have enhanced outcomes following aesthetic surgery. However, surgical site infections (SSI) continue to result in increased morbidity, mortality, and cost of care. The true incidence rate of SSI in aesthetic surgery is unknown due to the lack of a national surveillance system, but studies of SSI across surgical specialties have suggested that many of these infections are preventable. Patient-related factors-including obesity, glycemic control, and tobacco use-may contribute to the development of SSI following aesthetic surgery. In terms of SSI prevention, proper handwashing and surgical skin preparation are integral. Furthermore, the administration of prophylactic antibiotics has been shown to reduce SSI following many types of surgical procedures. Unfortunately, there are few large, randomized studies examining the role of prophylactic antibiotics in aesthetic surgery. The authors review the medical literature, discuss the risks of antibiotic overutilization, and detail nonpharmacological methods for reducing the risk of SSI.
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Affiliation(s)
- Michael A Lane
- Infectious Diseases Division, Washington University School of Medicine, St. Louis, Missouri, USA.
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28
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Kreymerman PA, Isakov R. Abdominoplasty. Plast Reconstr Surg 2010. [DOI: 10.1007/978-1-84882-513-0_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Throckmorton AD, Boughey JC, Boostrom SY, Holifield AC, Stobbs MM, Hoskin T, Baddour LM, Degnim AC. Postoperative Prophylactic Antibiotics and Surgical Site Infection Rates in Breast Surgery Patients. Ann Surg Oncol 2009; 16:2464-9. [DOI: 10.1245/s10434-009-0542-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 05/13/2009] [Accepted: 05/15/2009] [Indexed: 11/18/2022]
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30
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Tadiparthi S. Prophylactic antibiotics for clean, non-implant plastic surgery: what is the evidence? J Wound Care 2008; 17:392-4, 396-8. [DOI: 10.12968/jowc.2008.17.9.30938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Tadiparthi
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK
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31
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Gravante G, Caruso R, Araco A, Cervelli V. Infections after plastic procedures: incidences, etiologies, risk factors, and antibiotic prophylaxis. Aesthetic Plast Surg 2008; 32:243-51. [PMID: 18080159 DOI: 10.1007/s00266-007-9068-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Through a review of the English literature, this study aimed to assess the incidence, etiology, risk factors, and preventive measures for postoperative infections occurring after plastic surgery operations. METHODS All studies describing the occurrence of infections after plastic surgery procedures including case reports, prospective trials, and retrospective series were selected. RESULTS The 85 articles analyzed showed that incidences differ greatly among procedures and seem to be influenced by different and specific risk factors for each operation. Etiologic agents are primarily bacteria, although mycobacteria, virus, and fungi also have been described. No agreement exists on the use of antibiotic prophylaxis, except for abdominoplasties, because few specific prospective trials are present in the literature. CONCLUSIONS Infections remain an important problem in plastic surgery with different points that still need to be clarified. Hopefully, in the future prospective randomized trials will definitively address this issue in order to provide plastic surgeons with clear and unbiased guidelines on its prevention and management.
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Affiliation(s)
- G Gravante
- Department of General Surgery, University of Tor Vergata in Rome, Ciampino (Roma) 00043, Italy.
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