Plastic & Reconstructive Surgery: June 2015 - Volume
135 - Issue 6 - p 1723–1739 doi: 10.1097/PRS.0000000000001265
Ariyan, Stephan et al
Background: There is
a growing concern for microbial resistance as a result of overuse of
antibiotics. Although guidelines have focused on the use of antibiotics for
surgery in general, few have addressed plastic surgery specifically. The
objective of this expert consensus conference was to evaluate the evidence for
efficacy and safety of antibiotic prophylaxis in plastic surgical procedures.
Methods: The authors:
searched for existing high-quality systematic reviews for antibiotic
prophylaxis in the literature from the MEDLINE, Cochrane Library, and Embase
databases. All synonyms for antibiotics were combined with terms for relevant
plastic surgery procedures. The searches were not limited by language, and
included all study designs. In addition, supplemental hand searches were
performed of bibliographies of relevant articles, and extensive “related
articles.” Meta-analyses were performed and reviewed by experts selected by the
American Association of Plastic Surgeons to reach consensus recommendations.
Results: Database
searches identified 4300 articles, from which 2042 full-text articles were
identified for eligibility. De novo meta-analyses were performed for each
plastic surgical category. In total, 67 studies met the inclusion criteria,
including nine for breast surgery, 17 for head and neck surgery, 10 for
orthognathic surgery, seven for rhinoplasty/septoplasty, 19 for hand surgery,
five for skin surgery, and two for abdominoplasty.
Conclusions: Systemic
antibiotic prophylaxis is recommended for clean breast surgery and for
contaminated surgery of the hand or the head and neck. It is not recommended to
reduce infection in clean surgical cases of the hand, skin, head and neck, or
abdominoplasty.
