Perioperative antibiotics in the setting of microvascular free tissue transfer: current practices.

Microvascular free tissue transfer is a ubiquitous and routine method of restoring anatomic defects. There is a paucity of data regarding the role of perioperative antibiotics in free tissue transfer. We designed a survey to explore usage patterns among microvascular surgeons and thereby define a standard of care. A 24-question survey regarding the perioperative antibiotic use in microvascular head and neck, breast, and lower extremity reconstruction was sent to all those members of the American Society for Reconstructive Microsurgery who had registered e-mail addresses ( N = 450). Ninety-nine members responded. A first-generation cephalosporin is the most frequent choice of perioperative antibiotics across most categories: 93.5% for breast, 59.2% for head and neck, 91.1% for nontraumatic lower extremity, and 84.9% for traumatic noninfected lower extremity reconstruction. In penicillin-allergic patients, clindamycin is the most common choice. For traumatic lower extremity reconstruction in the presence of soft tissue infection or osteomyelitis, culture and sensitivity results determine the selection of perioperative antibiotics in 74%. A first-generation cephalosporin is the standard of care for perioperative antibiotic use in microvascular breast, head and neck, nontraumatic lower extremity, and traumatic noninfected lower extremity reconstruction. No consensus exists regarding the appropriate duration of coverage. These data may serve as a guide until a large controlled prospective trial is performed and a standard of care is established.

Intracranial volumes in a large series of healthy children.

BACKGROUND: Craniosynostosis alters the normal growth of the infant skull and can influence intracranial pressure and intracranial volume. The purpose of this study was to measure intracranial volumes in a large series of healthy children to serve as a reference for further studies exploring the impact of craniosynostosis and vault remodeling on intracranial growth. METHODS: A total of 123 children were included in this study from a retrospective review of pediatric emergency room visits for evaluation of head trauma where a head computed tomography scan was performed. Intracranial volumes were obtained using a semiautomated image segmentation technique and volume-rendering software. RESULTS: Volume measurements were obtained and plotted against age, and a best fit curve approximation was derived. In this study of healthy children, intracranial volume doubled by 9 months of age and tripled by 6 years of age. CONCLUSIONS: This large study contributes to the existing data demonstrating intracranial volumes in healthy children up to 6 years of age. These data can be used by clinicians as a reference in the assessment of a child presenting with cranial dysmorphology.