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Fri, 25 May 2012 05:22:37 -0500
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Plastic Surgery jobs in "Houston" - TX
Tue, 22 May 2012 12:15:44 -0600
 Our expanding private practice seeks a BE/BC fellowship trained hand surgeon (Ortho, plastics or general) to join a very successful hand surgery practice. lucrative guaranteed base salary
PLASTIC SURGERY jobs in "45 Minutes North of Chicago, Illinois Plastic Su" - IL
Fri, 18 May 2012 12:15:44 -0600
Joining private practice of one Plastic Surgeon. Busy practice Office located 45 Minutes North of Chicago Physician works from 4 area hospitals Option for partnership Ideally would like

Aesthetic Plastic Surgery (Browse Results)

Changes in the Facial Skeleton With Aging: Implications and Clinical Applications in Facial Rejuvenation
Sat, 12 May 2012 06:18:43 -0000
Abstract  In principle, to achieve the most natural and harmonious rejuvenation of the face, all changes that result from the aging process should be corrected. Traditionally, soft tissue lifting and redraping have constituted the cornerstone of most facial rejuvenation procedures. Changes in the facial skeleton that occur with aging and their impact on facial appearance have not been well appreciated. Accordingly, failure to address changes in the skeletal foundation of the face may limit the potential benefit of any rejuvenation procedure. Correction of the skeletal framework is increasingly viewed as the new frontier in facial rejuvenation. It currently is clear that certain areas of the facial skeleton undergo resorption with aging. Areas with a strong predisposition to resorption include the midface skeleton, particularly the maxilla including the pyriform region of the nose, the superomedial and inferolateral aspects of the orbital rim, and the prejowl area of the mandible. These areas resorb in a specific and predictable manner with aging. The resultant deficiencies of the skeletal foundation contribute to the stigmata of the aging face. In patients with a congenitally weak skeletal structure, the skeleton may be the primary cause for the manifestations of premature aging. These areas should be specifically examined in patients undergoing facial rejuvenation and addressed to obtain superior aesthetic results. Level of Evidence IV  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. Content Type Journal ArticleCategory ReviewPages 1-8DOI 10.1007/s00266-012-9904-3Authors Bryan Mendelson, The Centre for Facial Plastic Surgery, 109 Mathoura Road, Toorak, VIC 3142, AustraliaChin-Ho Wong, W Aesthetic Plastic Surgery, Mount Elizabeth Novena Hospital, 38 Irrawaddy Road, #08 – 42, Singapore, 329563 Singapore Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
Announcements
Wed, 09 May 2012 05:54:35 -0000
Announcements Content Type Journal ArticleCategory AnnouncementsPages 750-752DOI 10.1007/s00266-012-9905-2 Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 36 Journal Issue Volume 36, Number 3
Treatment of Melasma With Oral Administration of Tranexamic Acid
Thu, 03 May 2012 13:59:39 -0000
Abstract Background  Melasma is a common pigmentary disorder among Asian women. The available therapies such as bleaching agents, chemical peeling, laser, and intense pulsed light are not satisfactory or safe. In the search to find a new treatment therapy for melasma, oral administration of tranexamic acid (TA) was studied clinically in Chinese patients. Methods  The study enrolled 74 patients. Tranexamic acid tablets were prescribed at a dosage of 250 mg twice daily for a therapeutic period of 6 months. All the patients were followed up for more than 6 months after the treatment. The effects of treatment were evaluated by two physicians independently and by the patient based on improvement of pigmentation and reduction in melasma size. These were graded into four levels: excellent, good, fair, and poor. Results  After 6 months of treatment, the effects were graded as follows: excellent (10.8 %, 8/74), good (54 %, 40/74), fair (31.1 %, 23/74), and poor (4.1 %, 3/74). Side effects of TA such as gastrointestinal discomfort (5.4 %) and hypomenorrhea (8.1 %) were observed, but no severe complications were found. The recurrence of melasma was observed in seven cases (9.5 %). Conclusions  Oral administration of TA is an effective and safe therapy for the treatment of melasma. Level of Evidence II   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 at www.springer.com/00266 Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00266-012-9899-9Authors Sufan Wu, Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People’s Hospital, #158 Shangtang Road, Hangzhou, 310014 People’s Republic of ChinaHangyan Shi, Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People’s Hospital, #158 Shangtang Road, Hangzhou, 310014 People’s Republic of ChinaHua Wu, Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People’s Hospital, #158 Shangtang Road, Hangzhou, 310014 People’s Republic of ChinaSheng Yan, Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People’s Hospital, #158 Shangtang Road, Hangzhou, 310014 People’s Republic of ChinaJincai Guo, Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People’s Hospital, #158 Shangtang Road, Hangzhou, 310014 People’s Republic of ChinaYi Sun, Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People’s Hospital, #158 Shangtang Road, Hangzhou, 310014 People’s Republic of ChinaLei Pan, Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People’s Hospital, #158 Shangtang Road, Hangzhou, 310014 People’s Republic of China Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
Striae Distensae After Breast Augmentation
Fri, 27 Apr 2012 06:00:30 -0000
Abstract Background  One known but not fully understood complication after breast augmentation is the new onset of stretch marks (striae distensae) on the surgically treated breast. To date, all publications on this subject have been case reports. No report has fully described the actual incidence, risk factors, or management of striae distensae after breast surgery. Methods  This study prospectively followed patients who underwent primary breast augmentation using silicone implants in a single group practice from 2007 to 2011. New-onset striae distensae were actively investigated. Time from surgery to the moment of striae onset, patient age, nulliparity, use of oral contraceptives, overweight, personal history of stretch marks, and other variables were evaluated. Results  A total of 409 patients were included in the study. In 19 cases (4.6 %), new-onset striae distensae after breast augmentation were observed. The population with striae distensae was significantly younger than the total population (29.56 vs 20.91 years; p = 0.012). Striae distensae also were more common in nulliparous than in multiparous women (8.29 vs 0.52 %; p = 0.006), overweight women (17.77 vs 3.02 %; p = 0.016), women using oral contraceptives (7.89 vs 0.55 %; p = 0.008), and women with a personal history of stretch marks (8.97 vs 3.36 %; p = 0.031). No relation was shown regarding implant pocket type, size, or profile. Conclusion  Striae distensae may be a common but underreported complication after breast augmentation. In this series, striae distensae developed in 4.6 % of the patients within 1 year after breast augmentation. Severity may vary from inconspicuous small marks (classifications 1 and 2) to wide red and active striae rubra (classifications 3 and 4). Nulliparity, use of oral contraceptives, overweight, personal history of stretch marks, and younger age were related to a higher incidence of striae distensae. The increased rates in these groups may be associated with their exposure to higher estrogen levels and the important role of this hormone in facilitating the formation of striae distensae. Further studies are needed to show whether changes in these risk factors (i.e., weight loss, contraceptive withdrawal) may help to decrease striae distensae rates is these populations. Level of Evidence IV  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 at www.springer.com/00266. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00266-012-9902-5Authors Filipe Volpe Basile, Plastic Surgery Department, Basile Medical Center, Av. Prof Joao Fiusa 2300, Ribeirao Preto, Sao Paulo 14024-230, BrazilArthur Volpe Basile, Department of Dermatology, Barão de Maua Medical School, Ramos de Azevedo 423, Ribeirao Preto, Sao Paulo, BrazilAntonio Roberto Basile, Plastic Surgery Department, Basile Medical Center, Av. Prof Joao Fiusa 2300, Ribeirao Preto, Sao Paulo 14024-230, Brazil Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
New Classification for Correction of Alar Retraction Using the Alar Spreader Graft
Fri, 27 Apr 2012 06:00:30 -0000
Abstract Background  Identifying the cause of alar retraction is essential for proper correction of this deformity. In secondary surgery, aimed primarily at cephalic orientation and medialization of the lateral crus, corrections involving spreading and lateralization of the lateral crus can achieve a more horizontal orientation. In their clinic, the authors have practiced the use of an alar spreader graft to support the spread of the lateral crus. For the lateral crus to move freely without any resistance, it is critical to release the nasal hinge and pyriform ligament. A frontal view of the alar notching and the direction of the lateral crus are highly important factors needed to determine the cause of alar retraction. This report describes a new classification system for alar retractions viewed from the front to aid in determining the cause of the retraction and the surgical management. Methods  From March 2008 to July 2010, 31 alar retractions were corrected using alar spreader grafts for patients showing clear alar retractions in frontal views. Results  Satisfactory results without severe complications were obtained in 30 cases, with undercorrection in only 1 case. The alar cartilage was completely released to facilitate lateralization and caudal mobilization. An alar spreader graft then was used to support the lateral crus until a biologic scar cast was formed. Conclusion  The use of alar spreader grafts to correct alar retractions provided consistently good results. The attempt also was made to enhance the treatment strategy based on this classification system derived from frontal views of alar retraction. Level of Evidence IV  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 at www.springer.com/00266. Content Type Journal ArticleCategory Original ArticlePages 1-10DOI 10.1007/s00266-012-9901-6Authors Jae Hoon Kim, April31 Aesthetic Plastic Surgery Clinic, 6-7th floor, Geonwoo Building, 120 Nonhyun-dong, Gangnam-gu, Seoul, 135-010 KoreaSung Wan Park, April31 Aesthetic Plastic Surgery Clinic, 6-7th floor, Geonwoo Building, 120 Nonhyun-dong, Gangnam-gu, Seoul, 135-010 KoreaWon Suk Oh, April31 Aesthetic Plastic Surgery Clinic, 6-7th floor, Geonwoo Building, 120 Nonhyun-dong, Gangnam-gu, Seoul, 135-010 KoreaJoo Heon Lee, April31 Aesthetic Plastic Surgery Clinic, 6-7th floor, Geonwoo Building, 120 Nonhyun-dong, Gangnam-gu, Seoul, 135-010 Korea Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
Is Ultracision Knife Safe and Efficient for Breast Capsulectomy? A Preliminary Study
Fri, 27 Apr 2012 06:00:28 -0000
Abstract Background  Silicone breast implants are used to a wide extent in the field of plastic surgery. However, capsular contracture remains a considerable concern. This study aimed to analyze the effectiveness and applicability of an ultracision knife for capsulectomy breast surgery. Methods  A prospective, single-center, randomized study was performed in 2009. The inclusion criteria specified female patients 20–80 years of age with capsular contracture (Baker 3–4). Ventral capsulectomy was performed using an ultracision knife on one side and the conventional Metzenbaum-type scissors and surgical knife on the collateral side of the breast. Measurements of the resected capsular ventral fragment, operative time, remaining breast tissue, drainage time, seroma and hematoma formation, visual analog scale pain score, and sensory function of the nipple–areola complex were assessed. In addition, histologic analysis of the resected capsule was performed. Results  Five patients (median age, 59.2 years) were included in this study with a mean follow-up period of 6 months. Three patients had Baker grade 3 capsular contracture, and two patients had Baker grade 4 capsular contracture. The ultracision knife was associated with a significantly lower pain score, shorter operative time, smaller drainage volume, and shorter drainage time and resulted in a larger amount of remaining breast tissue. Histologic analysis of the resected capsule showed no apoptotic cells in the study group or control group. Conclusions  The results suggest that ventral capsulectomy with Baker grade 3 or 4 contracture using the ultracision knife is feasible, safe, and more efficient than blunt dissection and monopolar cutting diathermy and has a short learning curve. Level of Evidence II  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 at www.springer.com/00266. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00266-012-9896-zAuthors Mathias Tremp, Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, SwitzerlandPietro G. di Summa, Division of Plastic, Reconstructive, and Aesthetic Surgery CHUV, University Hospital of Lausanne, Lausanne, SwitzerlandDominique Schaakxs, Division of Plastic, Reconstructive, and Aesthetic Surgery CHUV, University Hospital of Lausanne, Lausanne, SwitzerlandUlrich Rieger, Department of Plastic, Reconstructive, and Aesthetic Surgery, University Innsbruck, Innsbruck, AustriaWassim Raffoul, Division of Plastic, Reconstructive, and Aesthetic Surgery CHUV, University Hospital of Lausanne, Lausanne, SwitzerlandDirk J. Schaefer, Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, SwitzerlandDaniel F. Kalbermatten, Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

pubmed: 1529-4242

Infantile Hemangioma: Clinical Assessment of the Involuting Phase and Implications for Management.
Couto RA, Maclellan RA, Zurakowski D, Greene AK Infantile Hemangioma: Clinical Assessment of the Involuting Phase and Implications for Management. Plast Reconstr Surg. 2012 May 9; Authors: Couto RA, Maclellan RA, Zurakowski D, Greene AK Abstract BACKGROUND:: Infantile hemangioma involutes during childhood; the tumor decreases in size and its color fades. Reconstructive procedures are often withheld until the lesion stops improving. The purpose of this study was to determine the age at which involution of infantile hemangioma ends, and factors that influence its regression. METHODS:: Consecutive patients with infantile hemangioma managed between 2007 and 2011 were retrospectively studied. The outcome variable was age when the appearance of the infantile hemangioma ceased to improve. Predictive variables were gender, lesion size, location, tumor depth, ulceration, and history of treatment (local or systemic corticosteroid). RESULTS:: The study comprised 81 patients. Infantile hemangioma was located on the head/neck (79.0%), trunk (13.6%), or extremity (7.4%). Average tumor area was 9.3 ± 9.7cm. Twenty-six percent of the cohort was treated with corticosteroid during the proliferative phase and 87.6% underwent reconstruction for a residual deformity. Kaplan-Meier analysis estimated that involution ceased at a median age of 36 months (IQR, 30-42 months), and 92% of tumors completed involution by 48 months. Multivariate Cox proportional hazards regression model showed that gender (p=0.80), lesion size (p=0.09), location (p=0.77), tumor depth (p=0.74), ulceration (p=0.18) and previous local (p=0.73) or systemic (p=0.60) corticosteroid treatment did not influence regression. CONCLUSION:: Most infantile hemangiomas do not improve significantly after 3.5 years of age. Reconstructive procedures should be considered at this age; the tumor has been allowed to regress and the deformity is improved prior to the development of long-term memory and psychosocial morbidity. PMID: 22575857 [PubMed - as supplied by publisher]
NOVEL SURGICAL TECHNIQUE FOR FULL FACE TRANSPLANTATION.
Pomahac B, Pribaz JJ, Bueno EM, Sisk GC, Diaz-Siso JR, Chandawarkar A, Westvik TS, Malin EW, Eriksson E NOVEL SURGICAL TECHNIQUE FOR FULL FACE TRANSPLANTATION. Plast Reconstr Surg. 2012 May 9; Authors: Pomahac B, Pribaz JJ, Bueno EM, Sisk GC, Diaz-Siso JR, Chandawarkar A, Westvik TS, Malin EW, Eriksson E Abstract BACKGROUND:: Full face transplantation raises a new set of ethical concerns and technical difficulties when compared with partial face transplantation. Previously, it was thought that full face allografts must include bilateral superficial temporal and facial arteries, dictating the need for inclusion of donor parotid glands. This would lead to poor aesthetic outcomes and limit facial nerve coaptation to the level of the main trunk, which often results in synkinesias. We present a new approach to full facial allograft recovery based on blood supply from facial arteries alone. This approach eliminates the need to include parotid glands, enabling more distal coaptation of facial nerve branches and targeted innervation of effector muscles. The recovery can be reproducibly performed within 4 hours. METHODS:: Three mock cadaver dissections and three full face transplantations were performed. RESULTS:: Donor facial allografts were dissected in cranio-caudal and lateral-to-medial fashion. Individual facial nerve branches were cut medial to parotid glands and coapted to corresponding recipient nerve branches. With the exception of one parotid gland used to add bulk, parotids were generally not included in the allografts. Relevant sensory nerves were coapted. External carotid arteries were dissected, leaving only bilateral facial arteries as the primary arterial supply. All full facial allografts were well perfused immediately following transplantation, and are surviving. CONCLUSIONS:: We describe a new, simple, and reproducible technique of full facial allograft recovery that allows perfusion using only bilateral facial arteries. Our technique follows critical principles of targeted sensory and motor nerve coaptation. LEVEL OF EVIDENCE:: IV. PMID: 22575856 [PubMed - as supplied by publisher]
Operating Room Fires: Part II. Optimizing Safety.
Engel SJ, Patel NK, Morrison CM, Rotemberg SC, Fritz J, Nutter B, Zins JE Operating Room Fires: Part II. Optimizing Safety. Plast Reconstr Surg. 2012 May 9; Authors: Engel SJ, Patel NK, Morrison CM, Rotemberg SC, Fritz J, Nutter B, Zins JE Abstract BACKGROUND:: The second part of our study on operating room fires analyzes the construct of the nasal cannula used during facial surgery under conscious sedation with supplemental oxygen. This prospective study compares two common styles of nasal cannulas with a nasopharyngeal system described in our first report. METHODS:: Twenty patients underwent upper and/or lower lid blepharoplasty under conscious sedation using three methods of supplemental oxygen delivery: A MAC-SAFE nasal cannula, a Salter nasal cannula, and a nasopharyngeal system with cut ends of a cannula placed into a green-rubber nasopharyngeal tube. Oxygen concentrations were measured at 24 locations around the face for each method at a low (3L/min) and high flow rate (6L/min) using a random access mass spectrometer unit. RESULTS:: At both low and high oxygen flow rates, the median oxygen concentration at and above the nose was statistically lower (p<.001) using the nasopharyngeal system than either the MAC-SAFE or Salter nasal cannulas. In addition, the oxygen concentrations measured using the two nasal cannulas were more variable than the nasopharyngeal method, particularly at locations around and above the nose. CONCLUSION:: This study demonstrates that mass spectrometry oxygen readings around the face are similar to room air when the cut ends of the oxygen cannulas are passed down the nasaopharyngeal tube while readings are significantly higher when both nasal cannulas used in this study are analyzed. This suggests that the nasopharyngeal system that we describe represents a significantly safer means of oxygen delivery during conscious sedation. PMID: 22575855 [PubMed - as supplied by publisher]
A Systematic Review and Pooled-analysis of Peroneal Artery Perforators for Fibula Osteocutaneous and Perforator Flaps.
Iorio ML, Cheerharan M, Olding M A Systematic Review and Pooled-analysis of Peroneal Artery Perforators for Fibula Osteocutaneous and Perforator Flaps. Plast Reconstr Surg. 2012 May 9; Authors: Iorio ML, Cheerharan M, Olding M Abstract BACKGROUND:: This study evaluated the available literature on the density and location of peroneal artery perforators in the lower leg. Several studies have identified perforators in the setting of fibula osteocutaneous flaps utilizing cadaveric, anatomic and clinical models; however, there has been no true consensus on the optimal fibula interval to reliably capture these perforators for flap and skin paddle design. METHODS:: A systematic review of the MEDLINE and Cochrane databases was performed to identify all anatomic, clinical and radiographic reports of the locations of peroneal artery perforators in the lower leg. The locations of perforators were indexed along tenths of the total fibula length to incorporate a uniform format. A subgroup comparison of musculocutaneous (MC) and septocutaneous (SC) perforators was also performed. RESULTS:: 3 clinical and 6 cadaveric reports identified a total of 445 legs and 1,710 perforators. The 0.6 interval had the greatest total perforator frequency at 19.1%±1%, with 310 perforators, and a positive probability of 79.1%±2.1%. Chi-square analysis found no statistically significant difference between the 0.6 - 0.7 intervals (p=0.37), but a statistical difference in perforator frequency at the flanking intervals of 0.5 and 0.8 (p=0.0058 and 0.0019). Subgroup analysis of SC perforators was based on 345 legs and 608 perforators. The 0.6 interval was the densest with 110 perforators and a frequency of 18.1%±1.6%. The MC subgroup analysis found 292 legs and 831 perforators. The interval of densest MC perforators was at 0.4, with 157 perforators and a frequency of 18.9%±1.4%. CONCLUSION:: This systematic review and pooled-analysis of all available and complete peroneal artery perforator data demonstrates clustering over the 0.6 interval of the lateral leg. This interval should be considered during flap design and elevation to reliably capture irrigating perforators for free and local flap applications. PMID: 22575854 [PubMed - as supplied by publisher]
Observations on the survival and neovascularization of fat grafts interchanged between C57BL/6-gfp and C57BL/6 mice.
Jianhui Z, Chenggang Y, Long L, Yan Z, Kangkang W, Lihua L, Wei X, Shuzhong G Observations on the survival and neovascularization of fat grafts interchanged between C57BL/6-gfp and C57BL/6 mice. Plast Reconstr Surg. 2012 May 9; Authors: Jianhui Z, Chenggang Y, Long L, Yan Z, Kangkang W, Lihua L, Wei X, Shuzhong G Abstract BACKGROUND:: Autologous fat transplantation has become a prevalent option for soft-tissue augmentation throughout the body. However, there is still much controversy over whether the fat grafts have survived or have been replaced in the recipient sites and over how the vessels grow. METHODS:: After the C57BL/6-gfp mice (GFP mice for short) and C57BL/6 mice (B6 mice for short) were paired randomly, the inguinal fat was excised and cut into pieces with scissors, and the adipose granules about 0.2 ml (0.195g) were transplanted subcutaneously with syringes to the dorsa of the paired mice. Samples were obtained at different time intervals: 3 days, 7 days, 2 weeks, 4 weeks, 2 months, 3 months, and 4 months after the transplantation. Each fat sample was weighed to evaluate the graft volume. Histology, origin and densities of neovascularization were examined by immunohistochemistry staining. RESULTS:: At the time point of 4 months, there was no significant difference in either graft survival or histology evaluation. Histological evaluation manifested the normal physiological process of inflammation, neovascularization, remodeling and maturity at different time intervals. At the end point, the immunohistochemistry staining of CD34 showed that the capillary density of the fat graft: 31.3±3.9 capillaries/mm on the dorsa of the GFP mice and 29.6±3.2 capillaries/mm on the dorsa of the B6 mice, there existing no statistical significance. The α-SMA staining indicated that there were neovascularized vessels in both GFP and B6 fat grafts. CONCLUSIONS:: Fat grafts can survive and neovascularized vessels can grow from the recipient sites. Fat transplantation is feasible and will be more widely applied if fat graft survival is improved. PMID: 22575853 [PubMed - as supplied by publisher]
Once is Not Enough: Withholding Postoperative Prophylactic Antibiotics in Prosthetic Breast Reconstruction is Associated with an Increased Risk of Infection.
Clayton JL, Bazakas A, Lee CN, Hultman CS, Halvorson EG Once is Not Enough: Withholding Postoperative Prophylactic Antibiotics in Prosthetic Breast Reconstruction is Associated with an Increased Risk of Infection. Plast Reconstr Surg. 2012 May 9; Authors: Clayton JL, Bazakas A, Lee CN, Hultman CS, Halvorson EG Abstract BACKGROUND-: There has been a trend toward limiting perioperative prophylactic antibiotics. This trend is based on research not done in patients undergoing plastic surgery procedures. Our university hospital instituted antibiotic prescribing guidelines based on the Surgical Care Improvement Project (SCIP). An increase in the rate of surgical site infections (SSI) was noted in patients undergoing breast reconstruction. We sought to determine whether the change in antibiotic prophylaxis regimen affected rates of SSI. METHODS-: A retrospective study comparing patients undergoing breast reconstruction who received pre- and postoperative prophylactic antibiotics to a group who received only a single dose of preoperative antibiotic. Type of reconstruction and known risk factors for implant infection were noted. RESULTS-: 250 patients were included: 116 in the pre-SCIP group and 134 in the SCIP group. The overall rate of SSI increased from 18.1% to 34.3% (p=0.004). SSI requiring re-operation increased from 4.3% to 16.4% (p=0.002). Multivariate logistic regression demonstrated that patients in the SCIP group were 4.74 times more likely to develop a SSI requiring re-operation (95% CI 1.63-13.80). Obese patients (OR 4.99, 95% CI 2.03, 12.31), patients with a history of radiation therapy (OR 4.50, 95% CI 1.80, 11.29), and reconstruction with tissue expanders (OR 3.76, 95% CI 1.11. 12.83) were associated with increased rates of SSI requiring re-operation. CONCLUSIONS-: Withholding postoperative prophylactic antibiotics in prosthetic breast reconstruction is associated with an increased risk of SSI, re-operation, and thus reconstructive failure. The optimal duration of postoperative prophylactic antibiotic use is the subject of future study. LEVEL OF EVIDENCE:: III. PMID: 22575852 [PubMed - as supplied by publisher]

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