Borrelli Mimi R, Sinha Vikram, Landin Madeleine L, Chicco Maria, Echlin Kezia, Agha Riaz A, Ross Alastair MacKenzie
Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA, United States.
King's College London, Guy's, King's and St Thomas' School of Medicine, Guy's Campus, Great Maze Pond, London SE1 9RT, UK.
Int J Surg Protoc. 2019 Feb 28;14:14-18. doi: 10.1016/j.isjp.2019.02.001. eCollection 2019.
There is little evidence-based guidance on the use of prophylactic antibiotics in skin surgery; whilst antibiotics may protect against surgical site infections (SSI), they have associated side effects, increase the risk of adverse events, and can propagate antibiotic resistance. We present a protocol for a systematic review to establish whether the benefit of prophylactic antibiotics overrides the risk, for patients undergoing autograft surgery.
The systematic review will be registered a priori on researchregistry.com and will be conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A search strategy will be devised to investigate 'skin graft surgery and use of antibiotics'. The following electronic databases will be searched, 1979-2018: PubMed, MEDLINE®, EMBASE, SCOPUS, CINAHL, PsychINFO, SciELO, The Cochrane Library, including the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effect (DARE), the Cochrane Methodology Register, Health Technology Assessment Database, the NHS Economic Evaluation Databases and Cochrane Groups, ClinicalTrials.gov, Current Controlled Trials Database, the World Health Organisation (WHO) International Clinical Trials Registry Platform, UpToDate.com, NHS Evidence and the York Centre for Reviews and Dissemination. Grey literature will be searched. All comparative study designs reporting on the use of antibiotics in skin graft surgery will be considered for inclusion, namely randomized controlled trials (RCTs). Two trained independent teams will screen all titles and abstracts, followed by relevant full texts, for eligibility. Data will be extracted under standardized extraction fields into a preformatted database. Note will be made of the indication for skin graft surgery (traumatic, congenital, malignant, benign), the graft site (head & neck, trunk, upper extremities, lower extremities), type of skin graft (split thickness, full-thickness). The primary outcome will be occurrence of SSI at the donor and/or recipient sites. Secondary outcomes, if reported, will include: length of hospital stay, revision surgery required, cost of medical care, time to wound healing and cosmetic outcome.
The systematic review will be published in a peer-reviewed journal and presented at national and international meetings within fields of plastic, reconstructive, and aesthetic surgery. The work will be disseminated electronically and in print. Brief reports of the review and findings will be disseminated to interested parties through email and direct communication. The review aims to guide healthcare practice and policy.
关于在皮肤外科手术中使用预防性抗生素，几乎没有基于证据的指导意见；虽然抗生素可能预防手术部位感染（SSI），但它们存在相关副作用，会增加不良事件风险，还可能导致抗生素耐药性。我们提出一项系统评价方案，以确定对于接受自体移植手术的患者，预防性抗生素的益处是否超过风险。
该系统评价将事先在researchregistry.com上注册，并将按照系统评价和荟萃分析的首选报告项目（PRISMA）进行。将设计一项检索策略来调查“皮肤移植手术与抗生素的使用”。将检索以下电子数据库，时间范围为1979年至2018年：PubMed、MEDLINE®、EMBASE、SCOPUS、CINAHL、PsychINFO、SciELO、考克兰图书馆，包括考克兰对照试验中心注册库（CENTRAL）、效果评价文摘数据库（DARE）、考克兰方法学注册库、卫生技术评估数据库、英国国家医疗服务体系经济评价数据库和考克兰小组、ClinicalTrials.gov、当前对照试验数据库、世界卫生组织（WHO）国际临床试验注册平台、UpToDate.com、英国国家医疗服务体系证据库以及约克评价与传播中心。将检索灰色文献。所有报告皮肤移植手术中抗生素使用情况的比较研究设计都将被考虑纳入，即随机对照试验（RCT）。两个经过培训的独立团队将筛选所有标题和摘要，随后筛选相关全文，以确定是否符合纳入标准。数据将在标准化的提取字段下提取到预先格式化的数据库中。将记录皮肤移植手术的指征（创伤性、先天性、恶性、良性）、移植部位（头颈部、躯干、上肢、下肢）、皮肤移植类型（分层厚度、全层）。主要结局将是供体和/或受体部位发生的SSI。如果有报告，次要结局将包括：住院时间、所需的翻修手术、医疗费用、伤口愈合时间和美容效果。
该系统评价将发表在同行评审期刊上，并在整形、重建和美容外科领域的国内和国际会议上展示。这项工作将以电子和印刷形式传播。该评价的简要报告和结果将通过电子邮件和直接沟通分发给感兴趣的各方。该评价旨在指导医疗实践和政策。
