In the weeks and months before an organized plastic surgery operation, much can be done to maximize the immune system and wound healing capabilities of the patient. Smokers should be encouraged to stop at least one month prior to their surgery. Smoking is really a known vasoconstrictor that can help to eliminate oxygen delivery to wounded tissue, and its effects have been discovered to last weeks beyond the point of quitting smoking.
The nutritional status from the patient should be taken into account as well. Obese patients should be encouraged to lose as much weight as you possibly can while maintaining a healthy, protein-rich diet, and in the malnourished hospitalized patient, even a short 5-7 day span of parenteral or enteral nutrition has been shown to significantly reduce the risk of SSIs.
Studies show that using a patient have a preoperative shower with an antiseptic soap (e.g., hexachlorophene) can reduce skin bacterial load. However, shaving the planned surgical site having a razor either the night before surgery or immediately preoperatively should be discouraged due to the transient bacterial infestation that it promotes. Studies report greater than a 3-fold increase in infection rates with shaving versus hair clipping (5.6 vs. 1.7%). Finally, known S. aureus carriers should have their nasal orifices treated with topical 2% mupirocin.
Intraoperatively, care should be come to keep the patient warm and well hydrated. This can improve blood flow to the wound and maximize oxygen delivery. Even Half an hour of preoperative warming can help to eliminate patient risk for SSI by two-thirds in certain cases. Adequate oxygenation is essential for cellular function and bacterial destruction via superoxide and peroxide formation.
Case length should be kept low, given the very fact that infection rates almost double for each hour an operation lasts. Tissues should be handled gently and electrocautery for hemostasis should be kept to a minimum. During the case, wounds should be kept moist and retractors should be released periodically to restore blood circulation. The tiniest possible suture diameter should be used to minimize foreign material in the wound, and also the prudent utilization of drains should be encouraged.
By serving as a conduit for bacterial invasion and preventing epithelial closure of wounds, drains probably cause more SSIs than they prevent plus they should be removed as quickly as possible. Antibiotic prophylaxis of an indwelling drain isn't indicated. High pressure pulse irrigation and topical antiseptic washes have been shown to constitute some benefit in the contaminated or dirty wound. Both throughout the case and postoperatively, blood glucose concentration should be kept under tight control (80-110 mg/dl). And lastly, postoperative nutrition should be optimized.
Controversy exists on be it appropriate to close contaminated wounds primarily. Studies in adults show that this practice can result in a higher rate of wound failure along with a greater cost of care. It is suggested that a delayed primary closure from the incision be used. This involves either placing untied sutures during the case that can later be cinched down, or using adhesive strips for closure when the wound is ready. Before time when the wound seems to have minimal debris with no apparent progressing erythema, wet-to-dry, twice daily packing should be used.
Antibiotic prophylaxis of clean surgical procedures is controversial with different single randomized trial that showed benefit in breast and groin hernia surgery. The controversy persists because the incidence of superficial surgical site infection was so high in the placebo group. Evidence that antibiotic prophylaxis is indicated for soft tissue procedures of other forms is lacking entirely, and prophylaxis cannot be recommended. If administered, antibiotic prophylaxis should be given before your skin incision is made, in support of as a single dose.
Additional doses aren't beneficial because surgical hemostasis renders wound edges ischemic by definition until neovascularization occurs, and antibiotics cannot get to the edges of the incision not less than the first Twenty four hours. Not only can there be lack of benefit, prolonged antibiotic prophylaxis actually increases the risk of postoperative infection.
Increasingly in the practice of plastic surgery, there is a tendency to leave closed-suction drains in spot for prolonged periods in the erroneous belief that the incidence of wound complications is reduced by prolonged drainage. Nothing might be more wrong.
Data indicate that the existence of a drain for more than 24 hours increases the risk of postoperative surgical site infection with MRSA. Closed suction drains should be removed as soon as possible, ideally within Twenty four hours. Prolonged antibiotic prophylaxis is often administered to "cover" a drain left in spot for a prolonged period. This is a prime example of error compounding error, and is a practice that must be abandoned.
Our website is not responsible for the information contained by this article. Webworldarticles.com is a free articles resource thus practically any visitor can submit an article. However if you notice any copyrighted material, please contact us and we will remove the article(s) in discussion right away.
This article was sent to us by:
Ralph C. Bennett at
02092011
1. Breast reconstruction and general types of free flaps
All articles in this directory are property of their respective authors. Additionally, read our Privacy Policy
© 2010 WebWorldarticles.com - All Rights Reserved. Partners: Gunblade Saga