If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
University of Helsinki and Helsinki University Central Hospital, Department of Infectious Diseases. Meilahden Kolmiosairaala, P.O. Box 372, 00029 HUS, Finland
Antibiotic prophylaxis is frequently used in plastic surgery procedures, despite 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 onwards. Randomized controlled trials (RCTs) were included in the primary review, while older RCTs and other studies were sought if two or fewer relevant RCTs were identified.
Overall, 28 relevant RCTs, two non-randomized trials and fifteen cohort studies were identified. While the number of studies for each type of surgery is limited, the data suggest that prophylactic systemic antibiotic may be unnecessary in non-contaminated 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 is 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.
Surgical site infection is a dreaded complication in plastic surgery as it may lead to a prolonged recovery period and unfavorable long-term sequelae. The postoperative infection rates reported in literature vary greatly, for example 3% to 41% for oropharyngeal cancer reconstructions, 0 to 0.3% for face lifts, 1 to 22% for breast reduction, 0 to 7% for breast augmentation, 0 to 29% for breast reconstruction and 0.2% to 32% for abdominoplasty.
Thus, reducing the bacterial load with perioperative antibiotic prophylaxis is attractive as an attempt to reduce the risk of a postoperative infection.
Data on the benefit of antibiotic prophylaxis in preventing postoperative surgical site infections in clean and clean-contaminated plastic surgery procedures is limited and few consensus guidelines to date exist on the topic.
Ariyan S. , Martin J. , Lal A. , Cheng D. , et al., Antibiotic Prophylaxis for Preventing Surgical-Site Infection in Plastic Surgery: An Evidence-Based Consensus Conference Statement from the American Association of Plastic Surgeons.Plast Reconstr Surg 2015 ;135:1723-1739.
Inappropriate use of prophylactic antibiotic exposes the patient to an unnecessary risk of treatment side effects, may stimulate development of bacterial resistance to antibiotics, and brings additional cost. Simple educational interventions can, however, be used to increase adherence to guidelines on antibiotic use.
The aim of this review is to provide an updated assessment of the benefits of antibiotic prophylaxis during clean and clean-contaminated plastic surgery procedures to guide clinical practice.
METHODS
A comprehensive review of literature was performed following the PRISMA guidelines.
A systematic literature search was done on 7 March 2022 on the databases Medline, Web of Science and Scopus with the terms shown in Table 1. The search was limited to articles published in English, January 2000 onwards. Randomized controlled trials (RCTs) on antibiotic prophylaxis in plastic surgery were included in the primary review. Studies on antiseptics such as chlorhexidine were not included in the review. For topics on which limited or no RCTs were identified, non-randomized trials and cohort studies were included. Previous reviews on the topic were used to identify any additional and older studies.
Ariyan S. , Martin J. , Lal A. , Cheng D. , et al., Antibiotic Prophylaxis for Preventing Surgical-Site Infection in Plastic Surgery: An Evidence-Based Consensus Conference Statement from the American Association of Plastic Surgeons.Plast Reconstr Surg 2015 ;135:1723-1739.
Studies published prior to January 2000 were included in the report when two or fewer more recent studies relevant to the question were identified.
Table 1Search terms for the systemic review of literature.
Database
Search terms
Medline and Web of Science
((antibiotic) AND (prophylaxis)) AND (((plastic surgery) OR (reconstructive surgery)) OR (dermatological surgical procedures))
Scopus
( TITLE-ABS-KEY ( antibiot* OR antibacterial* OR "anti* bacter*") AND TITLE-ABS-KEY ( "plast*surg*" OR ( reconst* W/2 surg*) OR ( dermat* W/2 surg*)) AND TITLE-ABS-KEY ( prophylaxis*)) AND NOT INDEX (medline)
Supplementary searches with no publication date restriction were performed on Medline for topics with limited prior results, using the terms shown in Table 2. Maxillofacial surgery, craniofacial surgery, cleft lip and palate surgery, hand surgery and burns treatment were excluded from the review.
Table 2Search terms for the focused supplementary searches.
Supplementary search topic
Search terms in Medline
Aerodigestive tract reconstruction
aerodigestive tract AND surgery AND antibiotic
Lipotransfer
lipotransfer OR lipofilling AND antibiotic liposuction AND antibiotic
Soft tissue tumor resection
soft tissue AND sarcoma AND surgery AND antibiotic
Meta-analyses were performed when two or more studies were identified assessing a comparable outcome. The Mentel-Haenszel method for dichotomous data was used to calculate pooled odds ratio estimates. The random-effects model was applied, and 95% confidence intervals are reported.
RESULTS
A flow diagram of the search results is shown in Fig. 1. Altogether 28 relevant RCTs, two non-randomized trials and fifteen cohort studies were identified. In addition, two systematic reviews with meta-analyses of older studies were included in the review, for topics where no recent studies were identified.
Fig. 1Results of the systematic literature search, performed on 7 March 2022. Modified from
No studies directly assessing the need of perioperative antibiotic in clean non-contaminated head and neck plastic surgery operations were identified. Indirectly addressing the question, a meta-analysis with 1423 patients from four RCTs and four patient series concluded that perioperative antibiotic treatment does not significantly reduce infections in this patient group (2% vs. 4%; OR 0.49; 95% CI 0.19 to 1.23; p = 0.13).
Ariyan S. , Martin J. , Lal A. , Cheng D. , et al., Antibiotic Prophylaxis for Preventing Surgical-Site Infection in Plastic Surgery: An Evidence-Based Consensus Conference Statement from the American Association of Plastic Surgeons.Plast Reconstr Surg 2015 ;135:1723-1739.
The analysis included studies between 1971 and 2011, three on neck dissection, two on thyroid surgery, one on otolaryngology, one on cleft lip and palate patients and one on auricular wounds healed by secondary intention.
The infection rate is low in clean head and neck surgery and no antibiotic prophylaxis is routinely recommended.
Ariyan S. , Martin J. , Lal A. , Cheng D. , et al., Antibiotic Prophylaxis for Preventing Surgical-Site Infection in Plastic Surgery: An Evidence-Based Consensus Conference Statement from the American Association of Plastic Surgeons.Plast Reconstr Surg 2015 ;135:1723-1739.
The quality of the evidence behind the recommendation is, however, low because it is based on only eight studies with operations in the studies not typical for plastic surgery practice, and three of the studies are over 20 years old.
No studies including operations such as facelifts or blepharoplasties were identified.
Rhinoplasty
Rhinoplasty and septoplasty involve breaching the nasal mucosa, and thus the operations are considered clean-contaminated. Only one RCT addressing the impact of antibiotic prophylaxis in open rhinoplasty was identified.
The study evaluated the effectiveness of a 12-day postoperative course of penicillin vs. placebo in 100 patients undergoing revision rhinoplasty and observed a reduction in the postoperative infection rate from 27% to 4%. Combining these data with two further RCTs evaluating the need of a perioperative antibiotic in septoplasty patients challenges the benefit from the perioperative antibiotic (OR 0.30; 95% CI 0.07 to 1.24; p = 0.10; Fig. 2).
However, the three RCTs identified were highly heterogenous (I2 81%) and the combined result not revealing a benefit from a perioperative antibiotic may reflect the fact that two of the studies included patients with minimal access septoplasty instead of open rhinoplasty.
Ariyan S. , Martin J. , Lal A. , Cheng D. , et al., Antibiotic Prophylaxis for Preventing Surgical-Site Infection in Plastic Surgery: An Evidence-Based Consensus Conference Statement from the American Association of Plastic Surgeons.Plast Reconstr Surg 2015 ;135:1723-1739.
The need for an extended postoperative course of antibiotics has been assessed by three RCTs with a total of 742 patients, two of which included only endonasal surgery and the third complex revision surgery.
. The studies did not demonstrate a benefit from the long antibiotic course in comparison with perioperative treatment (OR 1.17; 95% CI 0.60 to 2.27; p = 0.65; Fig. 3). The quality of evidence is low (Table 3).
Fig. 3Comparison of surgical-site infection after rhinoplasty with extended postoperative antibiotic treatment versus perioperative antibiotic in rhinoplasty.
Cephalosporins cefuroxime and cefazolin, and the combination of amoxicillin and clavulonic acid were used as the perioperative antibiotic in the RCTs. No studies comparing different antibiotic regimes were identified.
Aerodigestive tract reconstruction
For surgery that breaches the aerodigestive tract, the rates of postoperative infection are notable. Early randomized controlled studies included placebo groups with no perioperative antibiotic and observed infection rates at 36 to 87% in the placebo group.
A meta-analysis with 416 patients from eight RCTs published 1961-1995 demonstrated a significant benefit from perioperative antibiotic use in these patients (infection rate 16% vs 42%, OR 0.23; 95% CI 0.11 to 0.46, p < 0.0001).
Ariyan S. , Martin J. , Lal A. , Cheng D. , et al., Antibiotic Prophylaxis for Preventing Surgical-Site Infection in Plastic Surgery: An Evidence-Based Consensus Conference Statement from the American Association of Plastic Surgeons.Plast Reconstr Surg 2015 ;135:1723-1739.
However, with all of the studies being over 20 years old, and several of them discontinued early due to large differences in infection rate between the control and the antibiotic group, the quality of the evidence is low.
Ariyan S. , Martin J. , Lal A. , Cheng D. , et al., Antibiotic Prophylaxis for Preventing Surgical-Site Infection in Plastic Surgery: An Evidence-Based Consensus Conference Statement from the American Association of Plastic Surgeons.Plast Reconstr Surg 2015 ;135:1723-1739.
No more recent RCTs were identified targeting this question. With antibiotics, the reported perioperative infection rates in recent series on head and neck oncological reconstructions have varied between 11% and 46%, a value high enough not to provoke discussion of the necessity of the antibiotic prophylaxis.
The duration of the antibiotic prophylaxis has been evaluated in three RCTs on patients with flap reconstructions of defects involving the upper aerodigestive tract.
None of the studies demonstrated a benefit from extending the one-day prophylaxis to five days of treatment (overall 17% vs. 16%; OR 0.99; 95% CI 0.53 to 1.86; p = 0.98; Fig. 4). Although highly homogenous (I2 30%), the three studies evaluating the length of the antibiotic prophylaxis included less than 300 patients in total and two of them were published by the same author in the 1980’s. The quality of evidence is, thus, low (Table 3).
Fig. 4Comparison of surgical-site infection after aerodigestive tract reconstruction with perioperative antibiotic versus extended postoperative antibiotic treatment.
In three more recent retrospective series, the use of clindamycin alone has been associated with a significantly increased risk of postoperative infection when compared with other antibiotic regimes.
Thus, for patients with penicillin allergy that cannot use cephalosporins, clindamycin alone is not sufficient and an antibiotic to improve Gram-negative coverage is required.
Breast surgery
Reduction mammaplasty
The need for a prophylactic antibiotic treatment during reduction mammaplasty has been evaluated in one meta-analysis with a total of 584 patients that included four RCTs and one pseudo-randomized prospective trial.
The overall data support the use of perioperative antibiotic prophylaxis (10.5% vs. 19%; OR 0.42; 95% CI 0.20 to 0.85; p = 0.02) However, a sub-analysis of the three studies conducted in 2000’s does not demonstrate a benefit from the antibiotic prophylaxis (OR 0.62; 95% CI 0.36 to 1.08; p = 0.09; Fig. 5). The data is of moderate quality (Table 3). No support for a prolonged postoperative antibiotic treatment was observed in the single RCT or the prospective trial addressing the question (OR 1.80; 95% CI 0.40 to 7.99; p = 0.44).
No perioperative infections were observed in either group and no correlation between positive bacterial cultures and the development of capsular contracture during 12-month follow-up was detected. However, antibiotic prophylaxis led to a statistically significant decrease in bacterial growth in samples taken from the implant pocket perioperatively (7% vs 79%, p <0.001).
Two cohort studies evaluating the need of antibiotic in augmentation mammaplasty were identified, both with only one reported postoperative infection in the entire study population
The combined data form these studies does not indicate a benefit from prophylactic antibiotic (OR 0.49; 95% CI 0.05 to 4.64; p=0.54; Fig. 6). With only two infections in the 444 patients included in these studies and a combined infection rate of 0.7% in the placebo treated patients, the studies were likely underpowered to demonstrate a significant difference between the groups. Overall, the quality of evidence on this is very low (Table 3).
Fig. 6Comparison of surgical-site infection after breast augmentation with implants with perioperative systemic antibiotic treatment versus no antibiotic treatment.
The effectiveness of implant pocket irrigation in reducing postoperative infections has been evaluated in three retrospective studies, a total of 3746 patients.
Meta-analysis of the studies suggests a 48% reduction in the risk of postoperative infection with implant pocket irrigation (OR 0.50; 95% CI 0.31 to 0.80; p=0.004; Fig. 7).
The overall quality of the evidence is, however, low (Table 3). In addition, four retrospective series with 1584 patients revealed a trend towards reduction of capsular contracture with the irrigation (OR 0.30; 95% CI 0.08 to 1.15; p= 0.08).
Evaluation of Antibiotic Irrigation Versus Saline Irrigation in Reducing the Long-Term Incidence and Severity of Capsular Contraction after Primary Augmentation Mammoplasty.
Fig. 7Comparison of postoperative infection after implant pocket irrigation with antibiotics versus placebo during breast augmentation. Data reproduced from a review by Lynch and colleagues.
The need for antibiotic prophylaxis during breast reconstruction with an implant or an expander, with or without a concomitant flap reconstruction has been assessed in only a subsection of a RCT including a total of 16 patients.
The perioperative infection rate was observed to drop from 20% to 0% with a single dose of preoperative azithromycin, an antibiotic with limited effect against Staphylococci and Streptococci. A similar discordance between perioperative skin swab culture Staphylococcus sensitivity to the used prophylactic antibiotic and the risk of perioperative infection has been observed in a more recent prospective study.
Evaluation of Current Perioperative Antimicrobial Regimens for the Prevention of Surgical Site Infections in Breast Implant-Based Reconstructive Surgeries.
A large systematic review of 81 retrospective series with almost 15000 patients identified 90 patients without prophylactic antibiotic use for whom the perioperative infection rate was 14%, a marked difference to the 6% in 1077 patients receiving antibiotic for <24 h and the 6% in 13780 patients receiving antibiotics for longer.
With the absence of RCTs and prospective studies, but with a large number of patients in the retrospective series, the quality of evince is low (Table 3).
Similarly, only one RCT to date has evaluated the benefit from extended postoperative antibiotics in breast implant reconstruction patients.
The study, which included a total of 112 women undergoing breast reconstruction with a tissue expander and mesh, compared the postoperative infection rate in patients receiving antibiotics until drain removal with those receiving only 24 hours of antibiotic. No significant difference was observed between the groups (19% vs 22%; p = 0.82). Combining these data with three retrospective cohort studies, including a total of 765 patients, does not demonstrate a benefit from extended postoperative antibiotics in patients with implant-based breast reconstruction (OR 0.55; 95% CI 0.26 to 1.16; p=0.12; Fig. 8).
Once Is Not Enough: Withholding Postoperative Prophylactic Antibiotics in Prosthetic Breast Reconstruction Is Associated with an Increased Risk of Infection.
Once Is Not Enough: Withholding Postoperative Prophylactic Antibiotics in Prosthetic Breast Reconstruction Is Associated with an Increased Risk of Infection.
No RCT evaluating the need or duration of antibiotic treatment in autologous breast reconstruction was identified. A systematic review of retrospective series on the topic derived a total infection rate of 3% in 1468 women with autologous flap reconstructions and 5% in 427 women with combined autologous flap and implant reconstruction.
The studies included in the review had a variety of perioperative antibiotic regimes. One database study and one retrospective study have directly compared the impact of continuing antibiotic treatment for over 24 h.
With a total of 1292 patients, the studies do not demonstrate a statistically significant decrease in infection from the extended prophylactic antibiotic (OR 0.66; 95% CI 0.40 to 1.07; p= 0.09; Fig. 9). The quality of evidence is very low (Table 3).
Fig. 9Comparison of surgical-site infection after autologous reconstruction with extended antibiotic treatment versus <24 h of antibiotics.
The majority of positive wound or blood cultures in reduction and augmentation mammaplasty were Staphylococcus species (83% and 73%, respectively), as reported in a systemic review including a total of 2971 patients.
However, the culture results were reported for only 53 of the patients, challenging the informativeness of the review. Cephalexin, Cefalozin, Cefonicid and cloxacillin were the first line antibiotics in the reduction mammoplasty trials.
For implants, benzyl-penicillin plus dicloxacillin were used in the augmentation trial, cephalosporins for the cohort studies and azithromycin in the reconstruction trial.
Three RCTs assessing the need for perioperative antibiotics in skin surgery were identified. One involved lower limb skin excision with direct closure in a total of 48 patients and evaluated the effectiveness of a single dose oral cephalexin.
Prevention of Surgical Site Infection in Lower Limb Skin Lesion Excisions with Single Dose Oral Antibiotic Prophylaxis: A Prospective Randomised Placebo-Controlled Double-Blind Trial.
The second one involved 208 patients with non-melanoma skin cancer excised anywhere in the body, with the defect closed either directly or with a local flap and patients receiving either no antibiotic or a single perioperative dose of cefazolin.
The third one, using a single dose cephalexin, involved 154 patients who had a skin cancer excised from the nose or the ear, with the defect closed using either a local flap or a skin graft. Most of the wounds were closed immediately with twenty closed only after two days, a delay enabling histological analysis prior to closure.
Effect of a Single Prophylactic Preoperative Oral Antibiotic Dose on Surgical Site Infection Following Complex Dermatological Procedures on the Nose and Ear: A Prospective, Randomised, Controlled, Double-Blinded Trial.
Overall, the studies demonstrated a benefit from the antibiotic in reducing the likelihood of postoperative infection (OR 0.35; 95% CI 0.16 to 0.75; p=0.007; Fig. 10), with the reported rate of infection 7-36% in the placebo groups and 3-9% in the antibiotic groups. The quality of evince on this is moderate (Table 3). An additional RCT evaluated the effect of a three-day course of levofloxacin in 82 patients with auricular wounds left to heal through secondary intention. No reduction was observed in the wound infection rate, with one infection detected in each group.
The use of intraincisional, injected antibiotic has been assessed in the context of Mohs surgery in two RCTs with a total of 2080 wounds. Both intraincisional clindamycin and nafcillin were found to reduce the likelihood of surgical site infection (OR 0.18; 95% CI 0.05 to 0.68; p=0.01; Fig. 11).
The quality of evince on this is moderate (Table 3).
Fig. 11Comparison of surgical-site infection after clean skin surgery with intraincisional, injected perioperative antibiotics versus no antibiotic treatment.
Large RCTs of topical bacitracin or mupirocin, with 884 and 1291 treated wounds, respectively, did not demonstrate a reduction in the rate of surgical site infection in surgery of skin lesions.
In contrast, a RCT with 972 patients suggested a benefit from topical chloramphenicol ointment, applied once directly after wound closure after minor surgery in a general practice setting.
Does Single Application of Topical Chloramphenicol to High Risk Sutured Wounds Reduce Incidence of Wound Infection after Minor Surgery? Prospective Randomised Placebo Controlled Double Blind Trial.
A meta-analysis combining these three studies does not demonstrate a protective effect of antibiotic ointments on sutured wounds (OR 0.73; 95% CI 0.39 to 1.39; p=0.34; Fig. 12). The quality of evince on this is moderate (Table 3).
Fig. 12Comparison of surgical-site infection after clean skin surgery with antibiotic ointments on closed skin surgery wounds versus no antibiotic treatment.
No RTC assessing the impact of perioperative antibiotic treatment in abdominoplasty patients was identified. A prospective pseudorandomized, blinded study on 207 abdominoplasty patients found no statistically significant reduction in postoperative infections from prophylactic antibiotic treatment (OR for no antibiotics vs. perioperative or 3 days of antibiotics 0.47; 95% CI 0.18 to 1.23; p = 0.12).
However, the infection rates reported were 13% with no antibiotic, 4% with perioperative antibiotic and 9% with three days of antibiotic, potentially reflecting a benefit from the prophylactic antibiotic in an underpowered study. No other relevant studies were identified. Reflecting the prevalence of antibiotic use in body contouring procedures, a review on lower body lifts found that all 21 relevant case series that included any mention of antibiotics, recommended antibiotic prophylaxis of varying durations.
No RTCs on the effect of antibiotic prophylaxis in lipofilling procedures were identified. A single retrospective multicenter study with 340 lipofilling patients with various recipient sites compared perioperative antibiotic administration with prolonged antibiotics of over 72 h and found no difference in infection rates, fat necrosis or fat resorption.
The overall infection rate for the patients was 1%. No studies assessing the need for the perioperative antibiotic were identified. The overall quality of evidence is very low.
Soft tissue tumors
No RTCs or systemic reviews were identified on the use of prophylactic antibiotic treatment in soft tissue sarcoma surgery. A single center retrospective cohort study with a total of 958 patients treated over six years, with patients receiving either no antibiotics, a single-shot prophylaxis or continued antibiotic prophylaxis, reported that antibiotic use was not a protective factor in the formation of postoperative infection in univariate or multivariate analysis. The overall wound infection rate in the cohort was 15%, and the independent risk factors identified were obesity, comorbidities, high tumor grade, operation time over 120 min, and other complications.
No studies assessing the need for antibiotic prophylaxis during the resection of benign soft tissue tumors were identified. Thus, there is insufficient data to formulate clear recommendations on the use of antibiotic prophylaxis in soft tissue tumor surgery. The overall quality of evidence is very low.
Gender affirmation surgery
No studies were identified on the use of antibiotic prophylaxis in chest masculinization or feminization surgery, phalloplasty or vaginoplasty. One retrospective cohort study on 62 chest masculinization patients, most of whom received only perioperative antibiotics, reported only one superficial infection.
Antibiotic prophylaxis is widely used perioperatively during plastic surgery procedures, conceivably reflecting the concern of postoperative complications and the absence of convincing data against the need for the prophylaxis.
Here, a limited number of RCTs directly assessing the need for a perioperative antibiotic prophylaxis during clean and clean-contaminated plastic surgery procedures were identified. Reflecting the paucity of the data, majority of the procedures do not have level I evidence supporting the recommendation. Furthermore, for most procedures with level I evidence, the number of studies identified, the number of patients included in them and the number of postoperative infections, are small. Thus, the studies do not meet the criteria for optimal information size.
For topics where a trend toward a benefit from antibiotic prophylaxis is detected and mechanism-based reasoning supports the use of prophylaxis, the evidence supporting the recommendation is indicated to be of level V. The overall quality of evidence to guide decisions on the use of antibiotics is low or very low for most of the plastic surgery operations included in this review, translating to a downgrading of the level of evidence for the recommendation.
A noticeable finding of the meta-analysis is that the available data, although limited, do not support the use of antibiotic prophylaxis for over 24 h. A similar observation of the adequacy of the perioperative dosing has been made in several large retrospective studies on joint arthroplasty surgery, where a single prophylactic dose of antibiotic has not been shown to be associated with an increased risk of periprosthetic infection when compared with multiple doses.
Perioperative Antibiotic Prophylaxis: Single and 24-Hour Antibiotic Dosages Are Equally Effective at Preventing Periprosthetic Joint Infection in Total Joint Arthroplasty.
Similar Risk of Complete Revision for Infection with Single-Dose Versus Multiple-Dose Antibiotic Prophylaxis in Primary Arthroplasty of the Hip and Knee: Results of an Observational Cohort Study in the Dutch Arthroplasty Register in 242,179 Patients.
The main limitations of this review arise from the search strategy of primarily focusing on RCTs published on or after year 2000 and including older studies identified through citation searching only when two or fewer relevant RCTs were retrieved during the initial search. This, together with the inclusion of non-randomized trials and retrospective case series for topics where RCTs were sparse, may have led to an unbalanced representation of studies across the operations. However, the recommendations derived here for the use of perioperative antibiotic prophylaxis are in line with those presented in a recent review including exclusively on RCTs.
In addition, this review is, to our knowledge, the first review to present the data for the included studies across the topics in sufficient detail for the reader to assess its relevance to their practice. Several topics were excluded from this study. Pediatric craniofacial surgery and cleft surgery has been covered in a recent review.
The antibiotic regimes in burns treatment are complex, influenced by the exposures during the trauma and the unit-specific measures adopted to avoid the development of microbial resistance during the sometimes long hospital admissions.
Hand surgery is a separate surgical specialty in a number of European countries, including the review authors’, and was therefore excluded. A recent review on the topic is available.
Maxillofacial operations were considered to be outside the scope of core plastic surgery.
In conclusion, limited number of RCTs have been done on the need of antibiotic prophylaxis in clean and clean-contaminated plastic surgery. For operations where the efficient length of the antibiotic prophylaxis has been assessed, the data does not support the use of prophylactic antibiotic for more than 24 h. The strength of the evidence is, however, moderate at best. In particular, the generally low rate of perioperative infections means that many of the studies included in this review may not have included enough patients to demonstrate a potential benefit from the antibiotic use. Overall, more studies are needed to enable formation of evidence-based guidelines on the use of antibiotics during plastic surgery procedures in this era of increase in the prevalence of both plastic surgery operations and bacterial resistance to antibiotics.
Ethical approval
Not required.
Funding statement
No funding was received for the completion of this study.
Conflict of interest statement
None
REFERENCES
Gravante G.
Caruso R.
Araco A.
Cervelli V.
Infections after Plastic Procedures: Incidences, Etiologies, Risk Factors, and Antibiotic Prophylaxis.
Ariyan S. , Martin J. , Lal A. , Cheng D. , et al., Antibiotic Prophylaxis for Preventing Surgical-Site Infection in Plastic Surgery: An Evidence-Based Consensus Conference Statement from the American Association of Plastic Surgeons.Plast Reconstr Surg 2015 ;135:1723-1739.
Evaluation of Antibiotic Irrigation Versus Saline Irrigation in Reducing the Long-Term Incidence and Severity of Capsular Contraction after Primary Augmentation Mammoplasty.
Evaluation of Current Perioperative Antimicrobial Regimens for the Prevention of Surgical Site Infections in Breast Implant-Based Reconstructive Surgeries.
Once Is Not Enough: Withholding Postoperative Prophylactic Antibiotics in Prosthetic Breast Reconstruction Is Associated with an Increased Risk of Infection.
Prevention of Surgical Site Infection in Lower Limb Skin Lesion Excisions with Single Dose Oral Antibiotic Prophylaxis: A Prospective Randomised Placebo-Controlled Double-Blind Trial.
Effect of a Single Prophylactic Preoperative Oral Antibiotic Dose on Surgical Site Infection Following Complex Dermatological Procedures on the Nose and Ear: A Prospective, Randomised, Controlled, Double-Blinded Trial.
Does Single Application of Topical Chloramphenicol to High Risk Sutured Wounds Reduce Incidence of Wound Infection after Minor Surgery? Prospective Randomised Placebo Controlled Double Blind Trial.
Perioperative Antibiotic Prophylaxis: Single and 24-Hour Antibiotic Dosages Are Equally Effective at Preventing Periprosthetic Joint Infection in Total Joint Arthroplasty.
Similar Risk of Complete Revision for Infection with Single-Dose Versus Multiple-Dose Antibiotic Prophylaxis in Primary Arthroplasty of the Hip and Knee: Results of an Observational Cohort Study in the Dutch Arthroplasty Register in 242,179 Patients.
00230-9&id=gr1.jpg){kind=link}
00230-9&id=gr2.jpg){kind=link}
00230-9&id=gr3.jpg){kind=link}
00230-9&id=gr4.jpg){kind=link}
00230-9&id=gr5.jpg){kind=link}
00230-9&id=gr6.jpg){kind=link}
00230-9&id=gr7.jpg){kind=link}
00230-9&id=gr8.jpg){kind=link}
00230-9&id=gr9.jpg){kind=link}
00230-9&id=gr10.jpg){kind=link}
00230-9&id=gr11.jpg){kind=link}
00230-9&id=gr12.jpg){kind=link}