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Cannon S, Carr BR, Neal TW, Sarcos P, Bueno S, Finn RA. Are More Medically Complex Patients Who Undergo Complex Septorhinoplasty at an Increased Risk for Surgical Site Infection? J Oral Maxillofac Surg 2024:S0278-2391(24)00596-2. [PMID: 39053891 DOI: 10.1016/j.joms.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Prophylactic antibiotics are routinely prescribed by surgeons for their patients who undergo septorhinoplasty. However, the literature to support this remains controversial, especially in complex cases, those that require grafts, revision cases, extended surgical time, and an American Society of Anesthesiologists (ASA) value greater than or equal to 3. PURPOSE The study purpose was to evaluate for a potential association between increased anesthetic complexity and the risk for surgical site infection (SSI) following complex septorhinoplasty. STUDY DESIGN, SETTING, SAMPLE Retrospective cohort study of patients who underwent a complex septorhinoplasty between 2005 and 2022 at the Dallas Veterans Affairs Medical Center. Patients were excluded if they did receive a septorhinoplasty, did not follow up, or had insufficient records. INDEPENDENT VARIABLE All patients were assigned an ASA value prior to surgery, with an ASA value of 3 serving as this study's independent variable. MAIN OUTCOME VARIABLE The main outcome variable of interest was the development of a postoperative SSI, defined as findings consistent with cellulitis, purulence, or fistula development necessitating antibiotic treatment. COVARIATES The demographic covariates included patient age and sex. Clinical covariates included diabetes status, history of nasal trauma or surgery, and smoking status. The operative covariates were surgical duration, perioperative antibiotic, intraoperative complication, and type of cartilage graft used. ANALYSES χ2 Analysis and t-tests were used for calculations, with P values < .05 being considered significant. RESULTS A total of 182 patients were included in this study, 81 (45%) with an ASA ≤2 and 101 (55%) with an ASA of 3. A patient's age (P < .01), male sex (P < .01), and a diagnosis of diabetes (P < .01) were associated with an ASA value of 3. In total, there were 6 (3.3%) SSIs, with 2 (1%) occurring in those with an ASA of 3. An ASA value of 3 (P = .27, relative risk of .40) was not shown to be associated with an increased risk of SSI. CONCLUSION AND RELEVANCE Our results suggest that an ASA of 3 is not significant with regard to postoperative infection in patients who undergo a complex nasal septorhinoplasty, and prophylactic postoperative antibiotics are not warranted.
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Affiliation(s)
- Scott Cannon
- Resident, Oral & Maxillofacial Surgery, University of Texas Southwestern, Dallas, TX.
| | - Brian R Carr
- Resident, Oral & Maxillofacial Surgery, University of Texas Southwestern, Dallas, TX
| | - Timothy W Neal
- Resident, Oral & Maxillofacial Surgery, University of Texas Southwestern, Dallas, TX
| | - Patricia Sarcos
- Resident, Oral & Maxillofacial Surgery, University of Texas Southwestern, Dallas, TX
| | - Scott Bueno
- Resident, Oral & Maxillofacial Surgery, University of Texas Southwestern, Dallas, TX
| | - Richard A Finn
- Professor, Department of Surgery, Division of Oral and Maxillofacial Surgery, Department of Cell Biology-Anatomy, University of Texas Southwestern Medical Center; Chief, Oral and Maxillofacial Surgery, Veterans Administration North Texas Health Care System
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Toman J, Zachary Porterfield J, Randall MW, Kumar A, Farrior EH. Efficacy of 24 hours versus 5 days of prophylactic antibiotics for the prevention of surgical site infection in outpatient elective facial plastic surgery. JPRAS Open 2024; 40:68-76. [PMID: 38434944 PMCID: PMC10907514 DOI: 10.1016/j.jpra.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/28/2024] [Indexed: 03/05/2024] Open
Abstract
Background The discovery of penicillin marked a paradigm shift in medicine with the ability to treat previously life-threatening infections. Increasing antibiotic resistance as well as the risk of adverse reactions to antibiotics, however, creates pressures for judicious use. There continues to be debate about the role of prophylactic antibiotics in facial plastic surgery. This study explores the role of prophylactic antibiotic administration in elective outpatient facial plastic surgery by comparing 5 days versus 24 hours of antibiotic prophylaxis. Method A retrospective cohort study of all consecutive patients undergoing cosmetic procedures at an outpatient facial plastic surgical center who received either 5 days or 24 hours of prophylactic antibiotics was performed. The primary outcome was the need for postoperative antibiotics within 6 weeks of surgery. Results 204 patients met the inclusion criteria: 104 in the 5-day group and 100 in the 24-hour prophylaxis group. The overall infection rate was 3.4%: 3% in the 24-hour group and 3.8% in the 5-day group (p = 0.77). Subgroup analysis of clean-contaminated cases (n = 85) showed the rate of postoperative infections was 4.3%, all within the 5-day group. In clean cases (n = 119), the rate of postoperative infections was 4.2% (n = 5): 4.8% (n = 3) in the 24-hour group versus 3.5% (n = 2) in the 5-day group. Conclusions The results show that decreasing the duration of antibiotics was not associated with an increased risk of postoperative infection. Given that antibiotics are an increasingly precious commodity with rising rates of resistance, this study supports the use of decreasing postoperative antibiotics to 24 hours.
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Affiliation(s)
- Julia Toman
- University of South Florida, Department of Otolaryngology Head and Neck Surgery Division Facial Plastics and Reconstructive Surgery Morsani College of Medicine
| | - J. Zachary Porterfield
- University of South Florida, Department of Internal Medicine - Division of Infectious Diseases & International Medicine
- University of KwaZulu-Natal, Department of Otorhinolaryngology School of Clinical Medicine
| | - Michael W Randall
- University of South Florida, Department of Otolaryngology Head and Neck Surgery Division Facial Plastics and Reconstructive Surgery Morsani College of Medicine
| | - Ambuj Kumar
- University of South Florida, Department of Internal Medicine Morsani College of Medicine
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Stein MJ, Yuksel SS, Harrast J, Taub PJ, Matarasso A, Gosain AK. Clinical Practice Patterns and Evidence-Based Medicine in Rhinoplasty: A 10-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery. Aesthetic Plast Surg 2024; 48:1312-1320. [PMID: 37605029 DOI: 10.1007/s00266-023-03599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The American Board of Plastic Surgery (ABPS) has collected data on cosmetic surgery from member surgeons since 2003. These data offer valuable information on national trends in clinical practice. OBJECTIVES The present study was performed to analyze trends in rhinoplasty over the last decade. METHODS Tracer data were compared between two cohorts 2012-2016 (early cohort "EC") and 2017-2021 (recent cohort "RC"). Data included patient demographics and surgical techniques. Results were considered in the context of current EBM-based guidance in the plastic surgery literature. RESULTS Data from 730 rhinoplasties (270 EC and 460 RC) were analyzed. The median age was 30 years, and the most common patient concern was the nasal dorsum (79%). In the RC group, fewer patients voiced concerns about tip projection (58% vs 43%, p = 0.0002) and more complained of functional airway problems (38% vs 49%, p = 0.004). An open approach was most common (83%). Septoplasty (47% vs 52%, p = 0.005), caudal septum repositioning (14% vs 23%, p = 0.002), and tip rotation maneuvers (32% vs 49%, p < 0.0001) became more popular. There was also an increase in the use of spreader grafts (35% vs 45%, p = 0.01) and columellar strut grafts (42% vs 50%, p = 0.04), while there has been a decrease in alar base resection (17% vs 10%, p = 0.007) and non-cartilaginous dorsum/radix augmentation (9% vs 4%, p = 0.02). CONCLUSIONS ABPS tracer data provide an excellent resource for the objective assessment of procedures in plastic surgery. The present study is the first to highlight evolving trends in rhinoplasty over the last 10 years. 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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Affiliation(s)
- Michael J Stein
- Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Selcen S Yuksel
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL, 60611, USA
| | - John Harrast
- Data Harbor Solutions, American Board of Plastic Surgery, Philadelphia, PA, USA
| | - Peter J Taub
- American Board of Plastic Surgery and Division of Plastic and Reconstructive Surgery, Mount Sinai Medical Center, New York, NY, USA
| | - Alan Matarasso
- Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL, 60611, USA.
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The inguinal fold as a flaps bank: the inguinal fold island flap (IFI flap). Updates Surg 2022; 75:785-789. [PMID: 36520270 DOI: 10.1007/s13304-022-01441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
The aim of this article is to describe an island flap, harvested from the inguinal fold, which can be used for vulvar reconstruction: the inguinal fold island flap (IFI flap). IFI flap is indicated for reconstruction of defects of vaginal vestibule and labia minora and it could be raised bilaterally safeguarding regional symmetry and avoiding vaginal introitus or urethral distortion. This flap has been utilized to reconstruct defects after vulvar melanoma and squamous cell carcinoma resections and in one case to restore vaginal vestibule anatomy in a revision surgery in a transgender woman. IFI flap is an example of an "aesthetic/functional" reconstruction which could be proposed to younger patients too.
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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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Abstract
BACKGROUND Identifying risk factors is essential for preventing surgical site infections (SSIs) in dermatologic surgery. OBJECTIVE To analyze whether specific procedure-related factors are associated with SSI. METHODS This systematic review of the literature included MEDLINE, EMBASE, CENTRAL, and trial registers. The Newcastle-Ottawa Scale was used for risk bias assessment. If suitable, the authors calculated risk factors and performed meta-analysis using random effects models. Otherwise, data were summarized narratively. RESULTS Fifteen observational studies assessing 25,928 surgical procedures were included. Seven showed good, 2 fair, and 6 poor study quality. Local flaps (risk ratio [RR] 3.26, 95% confidence intervall [CI] 1.92-5.53) and skin grafting (RR 2.95, 95% CI 1.37-6.34) were associated with higher SSI rates. Simple wound closure had a significantly lower infection risk (RR 0.34, 95% CI 0.25-0.46). Second intention healing showed no association with SSI (RR 1.82, 95% CI 0.40-8.35). Delayed wound closure may not affect the SSI rate. The risk for infection may increase with the degree of preoperative contamination. There is limited evidence whether excisions >20 mm or surgical drains are linked to SSI. CONCLUSION Local flaps, skin grafting, and severely contaminated surgical sites have a higher risk for SSI. Second intention healing and probably delayed wound closure are not associated with postoperative wound infection.
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Incidence and Predisposing Factors of Postoperative Infection after Rhinoplasty: A Single Surgeon's 16-Year Experience with 2630 Cases in an East Asian Population. Plast Reconstr Surg 2022; 150:51e-59e. [PMID: 35511054 DOI: 10.1097/prs.0000000000009202] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study evaluated the incidence and clinical characteristics of postoperative infection following rhinoplasty. METHODS This article is a retrospective review of 2630 East Asian rhinoplasty cases performed by a single surgeon (Y.J.J.), from July of 2003 to June of 2018. There were 1595 male patients (69.9 percent) and 687 female patients (30.1 percent), and the median age was 31 years. The incidence of infection was compared between primary and revision cases and analyzed according to the materials used. The authors evaluated the organisms cultured and the timeframe of infection development and intervention. RESULTS There were 2134 primary and 496 revision cases. Materials included autologous costal cartilage (413 cases), conchal cartilage (572 cases), homologous fascia lata (829 cases), homologous costal cartilage (102 cases), Gore-Tex (373 cases), and silicone (32 cases). The authors identified 22 cases (0.84 percent) of postoperative infection, 18 of which were revision. Revision surgery had a 19-fold greater infection rate than primary surgery (3.63 percent versus 0.19 percent). Women were 3.6 times as likely to develop an infection ( p = 0.002). The infection rate using autologous costal cartilage was 3.39 percent, and that for simultaneous correction of a septal perforation was 8.57 percent. In 11 cases (50 percent), infection developed within 1 month after surgery (12 ± 7 days). Methicillin-resistant Staphylococcus aureus was cultured in eight cases. Infection manifested at the nasal tip in 45 percent and the caudal septum/columella in 32 percent of cases. Twenty cases (90.9 percent) underwent surgical débridement. CONCLUSION Revision rhinoplasty in women, requiring the use of costal cartilage or simultaneous correction of septal perforation, showed a higher risk of postrhinoplasty infection, which usually manifested at the nasal tip and caudal septum/columella and needed to be managed by surgical débridement. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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8
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Wilson A, Mair T, Williams N, McGowan C, Pinchbeck G. Antimicrobial prescribing and antimicrobial resistance surveillance in equine practice. Equine Vet J 2022; 55:494-505. [PMID: 35575046 DOI: 10.1111/evj.13587] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is an increasingly serious threat to human and animal health, therefore responsible use of antimicrobials in equine practice is vital. There is a need to have accurate, up to date data on antimicrobial prescribing in equine practice in the UK. OBJECTIVES To characterise current antimicrobial prescribing practices by equine veterinarians and to describe surveillance, audit processes and identification of AMR. STUDY DESIGN Online cross-sectional, questionnaire-based survey. METHODS An online questionnaire targeting veterinarians who treat horses in the UK and Europe was distributed. The questionnaire collected data on participants' country of origin, practice policies, prescribing practices including use of high priority critical antimicrobials. Four common clinical case-based scenarios were included to further explore prescribing practice. Responses were compared using both descriptive statistics and multivariable logistic regression models. RESULTS Questionnaires were completed by 264 veterinarians from Europe (n=33/264) and the UK (n=231/264); 87% respondents worked only with horses and 67% worked at premises with hospitalisation facilities. Approximately half of respondents (54.4%) had a written antimicrobial use or stewardship policy within their practice. Over half of respondents did not perform any environmental surveillance (54.2%), audit of clinical infections (53.1%) or audit of infection control (57.1%). Potentiated sulphonamides were cited as the most used antimicrobial, although 44% reported using enrofloxacin in the last year and 66% used 3rd or 4th generation cephalosporins. Prophylactic antimicrobials before clean surgery were frequently/always prescribed by 48% respondents and 24% respondents frequently/always prescribed antimicrobials post-operatively in clean surgery. MAIN LIMITATIONS Potential selection bias of respondents, given individuals volunteered to take part in the survey. CONCLUSIONS Compared to a previous similar study conducted in 2009, overall antimicrobial usage appeared to be declining in clinical scenarios and a greater proportion of practices now have stewardship policies. However, the use of high priority critical antimicrobials is still relatively common in equine practice in the UK and Europe.
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Affiliation(s)
- A Wilson
- Department of Equine Clinical Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - T Mair
- Bell Equine Veterinary Clinic, Mereworth, Kent, UK
| | - N Williams
- Department of Equine Clinical Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - C McGowan
- Department of Equine Clinical Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - G Pinchbeck
- Department of Equine Clinical Science, Institute of Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
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Esposito S, Sgarzani R, Bianchini S, Monaco S, Nicoletti L, Rigotti E, Di Pietro M, Opri R, Caminiti C, Ciccia M, Conti G, Donà D, Giuffré M, La Grutta S, Lancella L, Lima M, Lo Vecchio A, Pelizzo G, Piacentini G, Pietrasanta C, Puntoni M, Simonini A, Venturini E, Staiano A, Principi N. Surgical Antimicrobial Prophylaxis in Pediatric Patients Undergoing Plastic Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11040506. [PMID: 35453257 PMCID: PMC9029976 DOI: 10.3390/antibiotics11040506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
For many years, it was clearly shown that surgical procedures might be associated with surgical site infection (SSI). Many scientific institutions prepared guidelines to use in surgery to reduce abuse and misuse of antibiotics. However, in the general guidelines for surgical antibiotic prophylaxis, plastic surgical procedures are not addressed or are only marginally discussed, and children were almost systematically excluded. The main aim of this Consensus document is to provide clinicians with recommendations on antimicrobial prophylaxis for pediatric patients undergoing plastic surgery. The following scenarios were considered: clean plastic surgery in elective procedures with an exclusive skin and subcutis involvement; clean-contaminated/contaminated plastic surgery in elective procedures with an exclusive skin and subcutis involvement; elective plastic surgery with use of local flaps; elective plastic surgery with the use of grafts; prolonged elective plastic surgery; acute burns; clean contused lacerated wounds without bone exposure; high-risk contused lacerated wounds or with bone exposure; contused lacerated wound involving the oral mucosa; plastic surgery following human bite; plastic surgery following animal bite; plastic surgery with tissue expander insertion. Our Consensus document shows that antimicrobial perioperative prophylaxis in pediatric patients undergoing plastic surgery is recommended in selected cases. While waiting the results of further pediatric studies, the application of uniform and shared protocols in these procedures will improve surgical practice, with a reduction in SSIs and consequent rationalization of resources and costs, as well as limiting the phenomenon of antimicrobial resistance.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
- Correspondence: ; Tel.: +39-0521-903524
| | - Rossella Sgarzani
- Servizio di Chirurgia Plastica, Centro Grandi Ustionati, Ospedale M. Bufalini, AUSL Romagna, 47521 Cesena, Italy;
| | - Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Erika Rigotti
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Marilia Di Pietro
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Roberta Opri
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy; (C.C.); (M.P.)
| | - Matilde Ciccia
- Neonatology and Neonatal Intensive Care Unit, Ospedale Maggiore, 40133 Bologna, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Mario Giuffré
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90141 Palermo, Italy;
| | - Stefania La Grutta
- Institute of Translational Pharmacology IFT, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Mario Lima
- Pediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | - Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Giorgio Piacentini
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Carlo Pietrasanta
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, 20122 Milan, Italy;
| | - Matteo Puntoni
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy; (C.C.); (M.P.)
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Meyer’s Children Hospital, 50139 Florence, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
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Schlager JG, Hartmann D, Wallmichrath J, Ruiz San Jose V, Patzer K, French LE, Kendziora B. Patient-dependent risk factors for wound infection after skin surgery: A systematic review and meta-analysis. Int Wound J 2022; 19:1748-1757. [PMID: 35229471 PMCID: PMC9615300 DOI: 10.1111/iwj.13780] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/13/2022] [Indexed: 12/02/2022] Open
Abstract
Postoperative wound infection in dermatologic surgery causes impaired wound healing, poor cosmetic outcome and increased morbidity. Patients with a high‐risk profile may benefit from perioperative antibiotic prophylaxis. The objective of this systematic review was to identify risk factors for surgical site infection after dermatologic surgery. In this article, we report findings on patient‐dependent risk factors. The literature search included MEDLINE, EMBASE, CENTRAL and trial registers. We performed meta‐analysis, if studies reported sufficient data to calculate risk ratios with 95% confidence intervals. Study quality was assessed according to the Newcastle‐Ottawa‐Scale. Seventeen observational studies that analysed 31213 surgical wounds were eligible for inclusion. Fourteen studies qualified for meta‐analysis. Nine studies showed good, three fair and five poor methodological quality. The reported incidence of surgical site infection ranged from 0.96% to 8.70%. Meta‐analysis yielded that male gender and immunosuppression were significantly associated with higher infection rates. There was a tendency towards a higher infection risk for patients with diabetes, without statistical significance. Meta‐analysis did not show different infection rates after excision of squamous cell carcinoma or basal cell carcinoma, but studies were substantially heterogenous. There was no significant association between risk for wound infection and smoking, age over 60 years, oral anti‐aggregation or anti‐coagulation or excision of malignant melanoma. In conclusion, the risk for surgical site infection in dermatologic surgery is low. Infection rates were increased significantly in male as well as immunosuppressed patients and non‐significantly in diabetics.
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Affiliation(s)
- Justin Gabriel Schlager
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Jens Wallmichrath
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Virginia Ruiz San Jose
- Department of Ear, Nose and Throat (Otolaryngology)-Head and Neck Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Kathrin Patzer
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Lars Emil French
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Benjamin Kendziora
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
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11
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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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Ruffolo AM, Sampath AJ, Colbert S, Golda N. Preoperative Considerations for the Prevention of Surgical Site Infection in Superficial Cutaneous Surgeries: A Systematic Review. Facial Plast Surg Aesthet Med 2020; 23:205-223. [PMID: 32721241 DOI: 10.1089/fpsam.2020.0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background: Surgical site infections (SSIs) pose challenges to the outcome of superficial cutaneous procedures. Objective: The objective of this study was to summarize published data regarding appropriate perioperative considerations to decrease SSI, including antiseptic use, topical decolonization, antibiotic prophylaxis, and clean versus sterile technique in superficial cutaneous procedures. A literature search was performed via PubMed and Cochrane Library by using relevant keywords. A total of 37 articles met the inclusion criteria. Strength of data was assessed according to the Oxford Centre criteria and a modified Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: Chlorhexidine is the antiseptic of choice in clean or outpatient superficial cutaneous procedures. Decolonization of carriers of Staphylococcus aureus with mupirocin is warranted for all superficial cutaneous procedures. Minor procedure rooms may be considered for superficial cutaneous procedures that possess an inherently low risk of SSI. Surgeons may consider nonsterile gloves instead of sterile gloves for clean or outpatient superficial cutaneous procedures. Postoperative use of topical antibiotics may be discontinued, as there are risks of adverse effects and increasing bacterial resistance without a significant reduction in SSI. Conclusion and Relevance: This systematic review provides new and updated evidence for the prevention of SSI in superficial cutaneous procedures through antiseptic use, antibiotic use, topical agents, and the surgical environment. The overall quality of evidence is good, with most articles being original research or systematic reviews. However, there is a need for dermatologic- and plastic surgery-specific studies regarding the prevention of SSI.
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Affiliation(s)
- Alexis M Ruffolo
- Division of Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Ashwath J Sampath
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Stephen Colbert
- Head of Hand and Microsurgery, Division of Plastic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Nicholas Golda
- Director of Dermatologic Surgery, Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri, USA
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Four Ways Plastic Surgeons Can Fight Climate Change. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2961. [PMID: 32802655 PMCID: PMC7413763 DOI: 10.1097/gox.0000000000002961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/11/2020] [Indexed: 11/25/2022]
Abstract
The climate crisis demands that surgeons reduce their environmental impact. Operating rooms are resource-intensive and are often wasteful. This makes them fitting targets for climate-conscious decision making.
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Olds C, Spataro E, Li K, Kandathil C, Most SP. Postoperative Antibiotic Use Among Patients Undergoing Functional Facial Plastic and Reconstructive Surgery. JAMA FACIAL PLAST SU 2020; 21:491-497. [PMID: 31647506 DOI: 10.1001/jamafacial.2019.1027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Best practices for antibiotic use after facial plastic and reconstructive procedures have been the subject of much debate, and there is a need for large-scale data to guide further development of evidence-based guidelines for antibiotic use in this setting. Objective To assess patterns of postoperative antibiotic prescriptions and infection rates after nasal and oculoplastic procedures. Design, Setting, and Participants A retrospective population-based cohort study was conducted using IBM MarketScan Commercial and Medicare Supplemental research databases of 294 039 patients who underwent facial plastic surgery procedures between January 1, 2007, and December 31, 2015. Patients were excluded if they were younger than 18 years, lacked continuous insurance coverage for 1 year before and after the procedure, or underwent additional procedures on the surgery date of interest. Statistical analysis was performed from January 1, 2007, to December 31, 2016. Main Outcomes and Measures Primary outcomes were antibiotic prescription patterns in the immediate postoperative period and rates of postoperative infectious complications. Explanatory variables included patient demographics, procedure type, and relevant comorbidities, which were used in multivariable logistic regression analysis. Results Of the 294 039 patients who met inclusion criteria (55.9% women and 44.1% men; mean [SD] age, 54.0 [18.6 years]), 45.2% filled prescriptions for postoperative antibiotics, including 55.3% of patients undergoing nasal procedures and 14.7% of patients undergoing oculoplastic procedures. Superficial surgical site infections occurred in 1.6% of patients, while deep surgical site infections occurred in 0.3% of patients. On multivariable logistic regression, patients receiving postoperative antibiotics were at significantly decreased risk of postoperative infections (nasal procedures: adjusted odds ratio [aOR], 0.144 [95% CI, 0.102-0.203]; oculoplastic procedures: aOR, 0.254 [95% CI, 0.104-0.622]) compared with those who did not receive postoperative antibiotics. Increased duration of postoperative antibiotics was not associated with reduced rates of infectious complications (nasal procedures: aOR, 1.000 [95% CI, 0.978-1.022]; oculoplastic procedures: aOR, 1.024 [95% CI, 0.959-01.092]). Despite being more likely to experience postoperative infections, patients with a history of tobacco use (aOR, 0.806 [95% CI, 0.747-0.870]), immunodeficiency (aOR, 0.774 [95% CI, 0.737-0.813]), or type 1 or 2 diabetes (aOR, 0.810 [95% CI, 0.772-0.850]) were less likely to be prescribed antibiotics than those without these conditions. Conclusions and Relevance Postoperative antibiotic prescriptions were associated with reduced rates of infections after facial plastic surgery. This study highlights the role of population-level data in the development of best practices for postoperative antibiotic use and identifies the need for additional examination of antibiotic use patterns and recommendations for populations at increased risk for postoperative wound infection.
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Affiliation(s)
- Cristen Olds
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California
| | - Emily Spataro
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Kevin Li
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California
| | - Cherian Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California
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Saadi R, Loloi J, Schaefer E, Lighthall JG. Outcomes of Cadaveric Allograft versus Autologous Cartilage Graft in Functional Septorhinoplasty. Otolaryngol Head Neck Surg 2019; 161:779-786. [PMID: 31385746 DOI: 10.1177/0194599819866812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our goal was to elucidate the efficacy and outcome profile of cadaveric allografts (homograft costal cartilage) in functional septorhinoplasty as compared with autografts (quadrangular cartilage, conchal cartilage, and autologous costal cartilage). STUDY DESIGN Retrospective chart review. SETTING Otolaryngology division of the Penn State Health Milton S. Hershey Medical Center. SUBJECTS AND METHODS A chart review of a single surgeon's practice was conducted with Current Procedural Terminology codes for septorhinoplasty (30410, 30420, 30430, 30435, 30450, 30465) from August 1, 2014, to August 1, 2017. All patients underwent functional septorhinoplasty for a chief complaint of nasal obstruction. Outcomes were collected up to 12 months following the operation and included the validated Nasal Obstruction Symptom Evaluation (NOSE), infection rate, malposition/warping of the graft, need for revision surgery, and graft loss. RESULTS A total of 171 cases were included in our data analysis. On multivariate analysis, there were no significant differences between patients who had autografts and those who had allografts in 3-, 6-, or 12-month postoperative NOSE score. Preoperative NOSE score was the only covariate to demonstrate a significant positive relationship to postoperative NOSE score. Regarding outcomes between autograft and allograft, no significant differences were found in rate of graft resorption (3.4% vs 5.6%, P = .680), graft warping (3.4% vs 0%, P = .309), infection (0% vs 1.9%, P = .316), or need for revision surgery (4.3% vs 5.6%, P = .709). CONCLUSION Autologous grafting is often the first choice in septorhinoplasty because of its presumed resistance to infection and resorption. Similar to autologous grafts, allografts are resistant to infection and resorption and demonstrate prolonged efficacy following functional septorhinoplasty.
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Affiliation(s)
- Robert Saadi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Justin Loloi
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Eric Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Urethral Reconstruction in Anterolateral Thigh Flap Phalloplasty: A 93-Case Experience. Plast Reconstr Surg 2019; 143:382e-392e. [PMID: 30688908 DOI: 10.1097/prs.0000000000005278] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Urethral reconstruction in anterolateral thigh flap phalloplasty cannot always be accomplished with one flap, and the ideal technique has not been established yet. In this article, the authors' experience with urethral reconstruction in 93 anterolateral thigh flap phalloplasties is reported. METHODS Ninety-three anterolateral thigh phalloplasties performed over 13 years at a single center were retrospectively reviewed to evaluate outcomes of the different urethral reconstruction techniques used: anterolateral thigh alone without urethral reconstruction (n = 7), tube-in-tube anterolateral thigh flap (n = 5), prelaminated anterolateral thigh flap with a skin graft (n = 8), anterolateral thigh flap combined with a free radial forearm flap (n = 29), anterolateral thigh flap combined with a pedicled superficial circumflex iliac artery perforator flap (n = 38), and anterolateral thigh flap combined with a skin flap from a previous phalloplasty (n = 6). Seventy-nine phalloplasties were performed for female-to-male sex reassignment surgery. The others were performed in male patients with severe penile insufficiency. RESULTS Urethral complication rates (fistulas and strictures) were as follows: tube-in-tube anterolateral thigh flap, 20 percent; prelaminated anterolateral thigh flap, 87.5 percent; free radial forearm flap urethra, 37.9 percent; superficial circumflex iliac artery perforator urethral reconstruction, 26.3 percent; and skin flap from previous phalloplasty, 16.7 percent. CONCLUSIONS When tube-in-tube urethra reconstruction is not possible (94.2 percent of cases), a skin flap such as the superficial circumflex iliac artery perforator flap or the radial forearm flap is used for urethral reconstruction in anterolateral thigh phalloplasties. Flap prelamination is a second choice that gives high stricture rates. If a penis is present, its skin should be used for urethral reconstruction and covered with an anterolateral thigh flap. With these techniques, 91.86 percent of patients are eventually able to void while standing. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Kaoutzanis C, Winocour J, Gupta V, Yeslev M, Ganesh Kumar N, Wormer B, Grotting JC, Higdon KK. The Effect of Smoking in the Cosmetic Surgery Population: Analysis of 129,007 Patients. Aesthet Surg J 2019; 39:109-119. [PMID: 29659716 DOI: 10.1093/asj/sjy088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Smoking has been associated with several postoperative adverse outcomes across multiple surgical disciplines, but the literature is limited for aesthetic surgical procedures. Objectives To compare complication rates between smokers and nonsmokers undergoing common cosmetic procedures, identify specific cosmetic procedures where smoking increases the risk of complications, and evaluate smoking as an independent risk factor for major complications following aesthetic surgery. Methods A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Smoking was evaluated as a risk factor for major complications requiring emergency room visit, hospital admission, or reoperation within 30 days after surgery. Multivariate regression analysis was performed controlling for the effects of age, gender, body mass index, type of surgical facility, type of procedure, and combined procedures. Results Of the 129,007 patients, 10,621 (8.2%) were smokers. All procedures examined, except breast augmentation, were more frequently performed in the nonsmoker cohort. Overall major complications were similar between smokers and nonsmokers (2.0% vs 1.9%, P = 0.57). In univariate analysis, surgical site infections (0.6% vs 0.5%, P = 0.04) were significantly higher among smokers, but suspected venous thromboembolism (0.2% vs 0.1%, P = 0.01) was significantly higher among nonsmokers. Notably, smokers had a higher risk of major complications after body procedures (2.9% vs 1.0%, P = 0.01), as well as thigh lifts (23.8% vs 3.6%, P < 0.01) and male breast surgery (3.7% vs 1.4%, P = 0.03). In multivariate analysis, smoking was found to be an independent predictor of surgical site infections (relative risk 1.61, P < 0.01). Conclusions Smoking is an independent risk factor of major surgical site infections following aesthetic surgery. Body procedures, as well as thigh lifts and male breast surgery, have higher complication rates in smokers. Level of Evidence 2
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Affiliation(s)
| | - Julian Winocour
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Varun Gupta
- Prima Center for Plastic Surgery, Duluth, GA
| | - Max Yeslev
- Southeast Permanente Medical Group, Atlanta, GA
| | - Nishant Ganesh Kumar
- Department of Surgery, Division of Plastic Surgery, University of Michigan, Ann Arbor, MI
| | - Blair Wormer
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - James C Grotting
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - K Kye Higdon
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
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The More the Merrier? Should Antibiotics be Used for Rhinoplasty and Septorhinoplasty?-A Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1972. [PMID: 30534507 PMCID: PMC6250483 DOI: 10.1097/gox.0000000000001972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/14/2018] [Indexed: 12/03/2022]
Abstract
Background: With antimicrobial resistance a global threat, optimizing antibiotic usage across the surgical continuum is vital. The American Academy of Otolaryngology—Head and Neck Surgery Foundation recently published the first guidelines addressing management in rhinoplasty. The authors reviewed pertinent literature on the role of systemic antibiotics in rhinoplasty and septorhinoplasty. Methods: The authors performed a MEDLINE search through PubMed using the key terms rhinoplasty, septorhinoplasty, infection, antimicrobials, and antibiotics. Results: Ten studies met criteria. Studies evaluating antibiotics perioperatively showed similar infection and/or bacteremia rates (0–13.3%) in those receiving or not receiving antibiotics. No patients experienced significant local/systemic infections regardless of antibiotic use. In the 3 studies evaluating antibiotics postoperatively, antibiotics decreased the infection rate from 27% to 8% in complex revision cases. In a study evaluating postoperative antibiotics in noncomplex cases, there were no significant differences in infection rates between those receiving only a preoperative dose and those receiving preoperative in addition to 7 days of postoperative antibiotics, with the latter experiencing higher rates of antibiotic-related adverse events and costs. Conclusions: Peri- and postoperative antibiotics in noncomplex rhinoplasty and septorhinoplasty are not beneficial in decreasing infection risk. Antibiotics, with a first-generation cephalosporin such as cefazolin (non–β-lactam, such as clindamycin, if β-lactam allergy), should be considered in patients with comorbidities/undergoing complex surgery. If perioperative antibiotics are used, antibiotics should be administered within 1 hour of incision and discontinued within 24 hours of the operation. Further research is warranted to evaluate the optimal duration of postoperative antibiotics in complex cases.
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D’arpa S, Cillino M, Mazzucco W, Rossi M, Mazzola S, Moschella F, Cordova A. An algorithm to improve outcomes of radial forearm flap donor site. Acta Chir Belg 2018; 118:219-226. [PMID: 29202648 DOI: 10.1080/00015458.2017.1411555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstarct Background: Due to the high rate of donor site complications the Radial Forearm Flap (RFF) has lost ground in favor of the Antero-lateral tight flap (ALT) and other flaps. We have designed a reconstruction algorithm for reconstruction of its donor site. The goal of this study was to retrospectively evaluate the impact of this algorithm on RFF donor site complication rates. METHODS The authors analyzed retrospectively 31 patients who underwent free radial forearm flap reconstruction between November 2009 and May 2013. Donor site complications were compared with data from patients treated before introdutction of the algorithm. Within the group were compared patients in which the flap was harvested suprafascial with those in which the flap was harvested as subfascial. RESULTS Before application of the algorithm, there was a 23.3% complication rate at the RFF donor site, in our experience. After introduction of the algorithm, complication rate has dropped to 3.2%, consisting in a partial skin graft necrosis treated by local wound-care and healed without further intervention. CONCLUSIONS Application of the algorithm described has led to a significant reduction in RFF donor site complication rates. This demonstrates that if flap donor sites are analyzed and tailor treated in the same way as primary defects are, instead of being given secondary importance and just grafted, outcomes improve.
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Affiliation(s)
- Salvatore D’arpa
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
- Deparment of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Michele Cillino
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Walter Mazzucco
- Cancer Registry of Palermo and Province Department for Health Promotion Science and Mother and Child, “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Matteo Rossi
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Sergio Mazzola
- Cancer Registry of Palermo and Province Clinical Epidemiology and Cancer Registry Operative Unit, University Hospital Policlinico “Paolo Giaccone”, Palermo, Italy
| | - Francesco Moschella
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Kaoutzanis C, Gupta V, Winocour J, Shack B, Grotting JC, Higdon K. Incidence and Risk Factors for Major Surgical Site Infections in Aesthetic Surgery: Analysis of 129,007 Patients. Aesthet Surg J 2017; 37:89-99. [PMID: 27694451 DOI: 10.1093/asj/sjw100] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Surgical site infections (SSIs) represent one of the most common postoperative complications in patients undergoing aesthetic surgery. OBJECTIVES This study reports the incidence and risk factors of major SSIs following aesthetic surgery. METHODS A prospective cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of a major SSI requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis evaluated potential risk factors for SSIs including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. RESULTS A total of 129,007 patients were identified, of which 599 (0.46%) had a major SSI. Mean age (43.8 ± 12.4 years vs 40.9 ± 13.9 years, P < .01) and BMI (27.3 ± 5.5 kg/m2 vs 24.3 ± 4.6 kg/m2, P < .01) were higher in patients with SSIs. Patients with a SSI were more likely to be smokers (10.5% vs 8.2%, P = .04) and diabetic (4.5% vs 1.8%, P < .01). Females suffered more SSI than males (0.5% vs 0.3%, P = .02). Trunk/extremity procedures had a higher incidence of SSI compared to breast or face procedures (0.9% vs 0.2%, P < .01). On multivariate analysis, independent predictors of SSI included age (Relative Risk [RR] 1.01), female gender (RR 1.86), BMI (RR 1.07), smoking (RR 1.61), diabetes (RR 1.58), hospital or ambulatory surgery center procedures (RR 1.39), trunk/extremity procedures (RR 2.42), and combined procedures (RR 1.88). CONCLUSIONS SSIs following cosmetic surgical procedures are associated with numerous independent predictors, which should be taken into consideration when counseling patients undergoing aesthetic surgery. LEVEL OF EVIDENCE 2 Risk.
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Affiliation(s)
- Christodoulos Kaoutzanis
- Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Varun Gupta
- Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Julian Winocour
- Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Bruce Shack
- Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - James C Grotting
- Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Kent Higdon
- Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
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Silberstein E, Shir-Az O, Reuveni H, Krieger Y, Shoham Y, Silberstein T, Bogdanov-Berezovsky A. Defensive Medicine Among Plastic and Aesthetic Surgeons in Israel. Aesthet Surg J 2016; 36:NP299-NP304. [PMID: 27277272 DOI: 10.1093/asj/sjw094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Defensive medicine (DM) includes medical practices that are aimed at avoiding liability rather than benefitting the patient. DM has not been well characterized among plastic surgeons. OBJECTIVES The authors examined the extents of intended and unintended DM among members of the Israeli Society of Plastic and Aesthetic Surgery (ISPAS) and identified risk factors for DM. METHODS A total of 108 ISPAS members were asked to complete a questionnaire that addressed physician attitudes toward DM and intended or unintended DM practices. RESULTS Seventy-eight surgeons (72.2% response rate) returned the questionnaire, although some questionnaires were returned incomplete. Forty respondents acknowledged practicing DM (ie, DM group), and 33 respondents did not (ie, non-DM group). There were no between-group differences in gender, years of practice, or number of previous litigations. Thirty-one percent of respondents in the DM group indicated that they avoid certain surgical procedures, compared with 6% of respondents in the non-DM group (P = .008). In private practice, 66.2% of respondents stated that they obtain written informed consent twice before surgery, and 100% request preoperative blood-coagulation testing. In contrast, 40% and 74% of respondents in public practice, respectively, acknowledged these behaviors (for consent, P = .027; for testing, P = .0059). Sixty-three percent of respondents prescribe antibiotics for more than 24 hours postoperatively, and this practice was slightly more common in the DM group (34 prescribe antibiotics vs 21 in the non-DM group; P = .079). CONCLUSIONS DM is highly integrated into the daily medical practices of plastic surgeons in Israel.
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Affiliation(s)
- Eldad Silberstein
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Ofir Shir-Az
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Haim Reuveni
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Yuval Krieger
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Yaron Shoham
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Tali Silberstein
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
| | - Alexander Bogdanov-Berezovsky
- Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center
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Affiliation(s)
- D Verwilghen
- Medicine and Surgery Section, Department of Large Animal Sciences, University of Copenhagen, Taastrup, Denmark
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Solitary Fibrous Tumor of the Lower Leg: A Rare and Difficult Diagnosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e528. [PMID: 26579334 PMCID: PMC4634165 DOI: 10.1097/gox.0000000000000501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 07/27/2015] [Indexed: 11/25/2022]
Abstract
Solitary fibrous tumor (SFT) is a rare neoplasm that commonly originates in the pleura. Extrapleural locations are rare and for this reason sometimes difficult to diagnose. Malignant forms with local recurrence or distant metastases have been reported, also as a consequence of inappropriate treatment. In this article, we report the case of an SFT of the lower leg in a 37-year-old man. Leg SFT is a rare occurrence, and differential diagnosis may be difficult because they can mimic a variety of benign and malignant mesenchymal tumors; immunohistochemical analysis for CD34, CD99, vimentin, and Bcl-2 is necessary. Misdiagnosis carries a significant risk of inadequate removal with subsequent increased risk of recurrence and distant metastases.
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Testa M, Stillo M, Giacomelli S, Scoffone S, Argentero PA, Farina EC, Zotti CM. Appropriate use of antimicrobial prophylaxis: an observational study in 21 surgical wards. BMC Surg 2015; 15:63. [PMID: 25968324 PMCID: PMC4434534 DOI: 10.1186/s12893-015-0048-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 05/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surveillance of Surgical Site Infections (SSI) in 2010 found 39 % compliance with hospital guidelines in Piedmont (Italy). The aim of the study was to estimate the appropriate use of antimicrobial prophylaxis and compliance with hospitals guidelines in surgical wards. METHODS This survey study took place in 21 surgery wards of 4 public hospitals. Forms were completed by public health resident doctors together with a medical ward referent and infection control nurses. 15 consecutive surgical procedures were randomly chosen from each ward. A total of 320 cases were analyzed. The study period was from July 2012 to January 2013. Data were collected using a survey form. A final score variable from 0 to 4 was given to each case. The results were compared with hospital and international guidelines. Data were analyzed using Epi-Info software. RESULTS Of the 320 cases collected, 63 were excluded; of the remaining 257 cases, 56.4 % of the procedures were appropriate (score 4), 15.2 % were acceptable and 28.4 % were not acceptable. The study found an unjustified continuation of antimicrobial prophylaxis in 17.1 % of the 257 cases, an unjustified re-start of antimicrobial therapy in 9.7 % and a re-dosing omission in 7.8 %. CONCLUSIONS The study demonstrated critical problems in antimicrobial prophylaxis management in surgical wards due to a lack of compliance between hospitals and national guidelines, a shortage of specific and updated recommendations for some surgical interventions and incorrect local specific procedures. Coordination between local and national recommendations, strengthening of evidence based decisions and continuous sharing of policy updates are needed.
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Affiliation(s)
- Marco Testa
- School of specialization in Hygiene and Preventive Medicine, Turin, Italy. .,Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Michela Stillo
- School of specialization in Hygiene and Preventive Medicine, Turin, Italy.,Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Sebastian Giacomelli
- School of specialization in Hygiene and Preventive Medicine, Turin, Italy.,Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Silvia Scoffone
- School of specialization in Hygiene and Preventive Medicine, Turin, Italy.,Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | | | - Enzo Carlo Farina
- Department of General Surgery, City of Science and Health, Turin, Italy
| | - Carla Maria Zotti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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Arora A, Roychoudhury A, Bhutia O, Pandey S, Singh S, Das BK. Antibiotics in third molar extraction; are they really necessary: A non-inferiority randomized controlled trial. Natl J Maxillofac Surg 2015; 5:166-71. [PMID: 25937728 PMCID: PMC4405959 DOI: 10.4103/0975-5950.154821] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Antibiotic resistance is now a serious problem, although it was not so only a few years ago. The need of the hour is to give clear evidence of the efficacy of antibiotic use, or lack thereof, to the surgeon for a procedure as common as mandibular third molar surgery. AIM This study aimed to evaluate whether postoperative combined amoxicillin and clavulanic acid in mandibular third molar extraction is effective in preventing inflammatory complications. STUDY AND DESIGN The study was structured as a prospective randomized double-blind placebo-controlled clinical trial. MATERIALS AND METHODS A study was designed wherein the 96 units (two bilaterally similar impacted mandibular third molars per head in 48 patients) were randomly assigned to two treatment groups (Group I and Group II). Each patient served as his/her own control. Each patient received 625 mg of combined amoxicillin and clavulanic acid 1 h before surgery. In the case of third molars belonging to Group I, 625 mg of combined amoxicillin and clavulanic acid TDS was continued for 3 days; in Group II, placebo in similar-looking packs was continued for 3 days. The patients were evaluated on the third and seventh postoperative days for signs of clinical infection and for microbial load evaluation. STATISTICAL ANALYSIS The data between the two groups were statistically analyzed by the two-tailed Fisher's exact test, with a 95% confidence interval. RESULTS The difference was not statistically significant between the test group and the control group with regard to erythema, dehiscence, swelling, pain, trismus, and infection based on microbial load. The data were statistically significant for alveolar osteitis, with the occurrence of alveolar osteitis (14.58%) in the placebo group. CONCLUSION Postoperative antibiotics are recommended only for patients undergoing contaminated, long-duration surgery.
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Affiliation(s)
- Ankit Arora
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Pandey
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Surender Singh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Bimal K Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Exposed subcutaneous implantable devices: an operative protocol for management and salvage. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e343. [PMID: 26034650 PMCID: PMC4448718 DOI: 10.1097/gox.0000000000000303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Implantable venous and electrical devices are prone to exposure and infection. Indications for management are controversial, but—especially if infected—exposed devices are often removed and an additional operation is needed to replace the device, causing a delay in chemotherapy and prolonging healing time. We present our protocol for device salvage, on which limited literature is available. Methods: Between 2007 and 2013, 17 patients were treated (12 venous access ports, 3 cardiac pacemakers, and 2 subcutaneous neural stimulators). Most patients were operated within 7 days from exposure. All patients received only a single perioperative dose of prophylactic antibiotic. In cases of gross infection (n = 1), the device was immediately replaced. In the absence of clinical signs of infection: Results: Sixteen devices were saved. Only one grossly infected pacemaker was removed and replaced immediately. Only in 1 case, exposure of a venous port recurred after 18 months and was successfully moved to a subpectoral pocket. Chemotherapy was always restarted as scheduled and electrical devices remained functional. Conclusions: This protocol allows—with a straightforward operation and simple measures—to save exposed devices even several days after exposure. Submuscular placement or immediate replacement is indicated only in selected cases.
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Infection in face-lift surgery: an evidence-based approach to infection prevention. Plast Reconstr Surg 2015; 135:58e-66e. [PMID: 25539351 DOI: 10.1097/prs.0000000000000824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complications in face-lift surgery are rare but can present a difficult experience for the patient and surgeon. It is the objective of this review to evaluate the clinical efficacy of routine perioperative safety measures in preventing surgical-site infection in face-lift surgery. METHODS A review of the literature was performed to assess the correlation of preoperative decolonization, prophylactic antibiotic use, perioperative hypothermia, body mass index, and smoking status with the incidence of surgical-site infection in cosmetic surgery, especially pertaining to face-lift surgery. RESULTS Studies supporting safe practice in cosmetic surgery and "clean" procedures are analyzed and discussed. CONCLUSION This article provides the current evidence on perioperative safety measures and recommendations regarding the prevention of infection in cosmetic surgery, especially in face-lift surgery.
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Verwilghen D, van Galen G, Weese JS. Shooting hard with antimicrobials: Is it really necessary? EQUINE VET EDUC 2014. [DOI: 10.1111/eve.12132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. Verwilghen
- Department of Large Animal Sciences; Faculty of Health and Medicine; University of Copenhagen; Denmark
| | - G. van Galen
- Department of Large Animal Sciences; Faculty of Health and Medicine; University of Copenhagen; Denmark
| | - J. S. Weese
- Department of Pathobiology and Centre for Public Health and Zoonoses, Ontario Veterinary College; University of Guelph; Ontario Canada
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e318280c6c2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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