J Reconstr Microsurg 2010; 26(6): 401-407
DOI: 10.1055/s-0030-1249606
© Thieme Medical Publishers

Perioperative Antibiotics in the Setting of Microvascular Free Tissue Transfer: Current Practices

Alyssa J. Reiffel1 , Mehul R. Kamdar2 , Daniel J.M Kadouch2 , Christine H. Rohde3 , Jason A. Spector2
  • 1Department of Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, New York
  • 2Division of Plastic Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, New York
  • 3Division of Plastic Surgery, Columbia University Medical Center, New York, New York
Further Information

Publication History

Publication Date:
10 March 2010 (online)

ABSTRACT

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.

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Jason A SpectorM.D. F.A.C.S. 

Weill Cornell Medical College, Payson 709-A

525 West 68th Street, New York, NY 10065

Email: jas2037@med.cornell.edu