The Role of Antibiotic Prophylaxis in Abdominoplasty: A Review of the Infection Rate in 300 Cases Treated without Prophylaxis

Sir: Abdominoplasties are routine plastic surgery procedures with a variety of minor and major complications. Few scientific publications have reported on their postoperative follow-up, but second to seroma, infection seems to be the most frequent complication.1 However, use of prophylactic antibiotics in clean surgery remains controversial. The administration of prophylactic antibiotics makes surgeons feel comfortable that they have done all they can to protect their patients against infection, but in most conditions, this action is not evidence-based. The widespread administration of antibiotics will inevitably lead to organism resistance. Can the use of prophylactic antibiotics in abdominoplasty be justified? Since we are unaware of any published study investigating the role of antibiotic prophylaxis in abdominoplasty, a 7-year retrospective audit was conducted on all abdominoplasties (n = 300 between April of 1998 and July of 2006) performed in our department. All patients underwent full abdominoplasty as the only primary procedure. No perioperative antibiotic prophylaxis was used. Since the umbilicus and genitalia may harbor potential pathogens, preoperative microbiology samples were taken as indicators. Postoperative wound controls were performed on a weekly basis until complete healing was settled. In case of wound drainage or signs of local infection, microbiology samples were taken. Oral antibiotic treatment was only started when local signs of infection were obvious. Thirty-one patients had postoperative wound drainage from which microorganisms were cultured. A course of antibiotics was needed in only 24 patients (8 percent), and all responded well to treatment. The remaining seven patients had increased wound drainage without signs of local wound infection, so they received no antibiotic treatment. Their positive wound swabs were attributed to bacterial colonization rather than infection. Staphylococcus appears to have been the most common infectious pathogen isolated. The majority of patients had no growth on their preoperative umbilical (87 percent) and genital (88 percent) swabs analysis. There was no correlation between preoperative and postoperative cultured microorganisms in those patients who developed wound infection. A literature review of complications in abdominoplasty revealed three studies that seem most applicable to this one. Grazer and Goldwyn showed a postoperative wound infection rate of 7.3 percent in a survey study of 10,490 abdominoplasty cases.2 Stewart et al. showed a wound infection rate of 3 percent in their series of 278 patients, but no information was provided on how these data were achieved and whether antibiotic prophylaxis was given.3 Chaouat et al. reported a wound infection rate of 7 percent in a retrospective case study of 258 abdominoplasties performed at St. Antoine Hospital, in Paris, France.1 Patients were given antibiotic prophylaxis in the form of either a single intravenous dose of amoxicillin or a 6-day postoperative course of penicillin G with metronidazole. A statistical comparison of these studies seems inappropriate given the unavoidably heterogeneous variables. Nevertheless, we would argue that our study produced comparable results in terms of wound infection rate in abdominoplasty in the absence of antibiotic prophylaxis when compared with Chaouat et al.'s study, which uses antibiotic prophylaxis. Our study suggests that abdominoplasty can be safely carried out without an increased risk of wound infection in the absence of antibiotic prophylaxis. B. Casaer, M.D. Department of Plastic and Reconstructive Surgery AZ St Jan Brugge, Belgium E. K. Tan, M.B.Ch.B. Department of Plastic and Reconstructive Surgery Northern General Hospital Sheffield, United Kingdom M. Depoorter, M.D.