Plast Reconstr Surg. 2015 Feb 20. [Epub ahead of print]
There is a growing concern for microbial resistance as a result of overuse of antibiotics. While 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 (CC) was to evaluate the evidence for efficacy and safety of antibiotic prophylaxis (AP) in plastic surgical procedures.
We searched for existing high-quality systematic reviews for AP in the literature from Medline, Cochrane Library, and Embase. 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 papers, and extensive "related articles". Meta-analyses were performed and reviewed by experts selected by the AAPS in order to reach consensus recommendations.
Database searches identified 4,300 articles, from which 2,042 full-text articles were identified for elegibility. De novo meta-analyses were performed for each plastic surgical category. In total, 67 studies met the inclusion criteria, including 9 for breast surgery, 17 for head and neck surgery, 10 for orthognathic surgery, 7 for rhinoplasty/septoplasty, 19 for hand surgery, 5 for skin surgery, and 2 for abdominoplasty.
Systemic AP is recommended for clean breast surgery, and for contaminated surgery of the hand, or head and neck. It is not recommended to reduce infection in clean surgical cases of the hand, skin, head and neck, or abdominoplasty.
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