Venous thromboembolism in plastic surgery: incidence, current practice and recommendations.

Venous thromboembolic events (VTEs) are an important concern due to their frequently asymptomatic presentation and significant morbidity and/or mortality. The true incidence of this disease process is unknown as (i) screening procedures and (ii) prophylaxis protocols are frequently lacking in this patient population. The purpose of this study was to identify published thromboprophylactic recommendations established in the plastic surgery literature and to provide a review on thromboembolism and current methods of prophylaxis. A systematic evaluation of all published guidelines for thromboembolism prophylaxis in plastic surgery was conducted. We report on 24 studies in favour of, and three studies against, mechanical and/or pharmacological prophylaxis. Thromboprophylactic recommendations were published by a small randomised trial (grade B, level 2), six retrospective studies (grade C, level IV), two literature reviews (grade C, level V), two surveys (grade C, level V), three narrative reviews (Continuing Medical Education) (grade C, level V) and 10 expert recommendations (grade C, level V). The three publications against prophylaxis were composed of a retrospective study (grade C, level IV) and two case series with no control group (grade C, level V). There is a significant paucity of category A or B evidence favouring thromboprophylaxis in the plastic surgery patient population. There is a need for further research in established thromboprophylaxis guidelines in plastic and reconstructive surgery.

Prevention of surgical site infection and appropriateness of antibiotic prescribing habits in plastic surgery.

OBJECTIVES: The use of antimicrobial prophylaxis against surgical site infection (SSI) is widespread in plastic surgery, while results from prospective randomised controlled trials in guiding antibiotic use are lacking. The purpose of this study was to identify the incidence and risk factors for SSI in plastic surgery, and to evaluate the appropriateness of prophylactic antibiotic prescribing habits in a tertiary university centre. METHODS: A retrospective chart review was conducted over a 6-month period. Co-morbidities, types of procedure, prophylactic antimicrobial administration, SSI rates, and clinical outcomes were evaluated. RESULTS: The incidence of SSI was 9.3% for 335 procedures. The cumulative incidence of SSI for breast surgery (n=80) was 16.3%, with a 78.8% prescription rate. For head and neck procedures (n=68), the incidence of SSI was 10.3%, with 80.9% of patients receiving antibiotic prophylaxis. For hand and upper limb procedures (n=170), 70.6% of patients received antimicrobial prophylaxis, with a 4.7% SSI incidence. According to category A prophylaxis guidelines published in the plastic surgery literature, over prescribing was identified in 27.5% of breast, 61.8% of head and neck, and 19.4% of hand and upper limb procedures. CONCLUSIONS: This is the first study evaluating appropriateness of antimicrobial prophylaxis use by plastic surgeons. Despite widespread use of prophylactic antibiotics, significant SSI rates were still present and frequently responsible for re-hospitalisations and re-interventions. The appropriateness of administration and indications for perioperative prophylactic antibiotic use must be evaluated.