Ramon A, Guillard T, Rosenstiel M, Bajolet O, Francois C
Chirurgie plastique reconstructrice et esthétique, hôpital Maison-Blanche, Reims, France.
CHU de Reims, Université de Reims Champagne-Ardenne, Inserm, laboratoire de bactériologie-virologie-hygiène hospitalière-parasitologie-mycologie, P3Cell, U 1250, Reims, France.
Ann Chir Plast Esthet. 2023 Aug;68(4):289-294. doi: 10.1016/j.anplas.2023.06.013. Epub 2023 Jul 15.
Surgical site infection (SSI) in plastic, reconstructive and aesthetic surgery (ERCP) is quite uncommon compared to other surgical specialities but remains one of the main complications. The aim of our study was to provide feedback on the systematic investigation of SSI in ERCP. This is a monocentric retrospective study, including all paediatric and adult patients who have undergone ERCP surgery between 01/01/2014 and 31/12/2021. During this period, the department systematically investigated all SSI cases. Eight thousand eight hundred and seventy-eight surgical procedures were performed. The SSI rate was 0.34%. Thirty SSIs (19W,11M), with a mean age of 56 years (none paediatric), were investigated. Twenty-seven patients suffered from comorbidities. The surgical indications included 17 cases of skin cancer, 7 cases of weight loss, 4 cases of breast reconstruction, 1 lipoma, 1 pectus excavatum. Eleven surgeries consisted in lymphnode procedures (8 sentinel lymphnodes, 3 curage). The average operating time was 116minutes. Nineteen patients received antibiotic prophylaxis. The average time to onset of SSI after surgery was 10 days. The most prevalent bacteria were commensals of the skin flora and the digestive tract. Apart from surgical management, 100% of patients were treated with antibiotics. High age, multiple comorbidities, long, combined procedures, placement of equipment, lymph node surgery, post-operative punctures on implanted equipment, are all risks factors for SSI. The implementation of a systematic monitoring of SSI within our department has provided us with the opportunity to analyse our data in real time and allow us to adjust our practices if necessary. This process can be used in other plastic reconstructive and aesthetic surgery departments. The collection and analysis of SSIs is both easily done and the procedure is well standardized. The assistance of the operational hygiene team is a key asset for the success of this project. The development of this type of procedure on a national level could be an asset to improve the management of SSI by taking advantage of the experience of a larger number of centres.
与其他外科专科相比,整形、重建及美容手术(ERCP)中的手术部位感染(SSI)相当少见,但仍是主要并发症之一。我们研究的目的是提供关于ERCP中SSI系统调查的反馈。这是一项单中心回顾性研究,纳入了2014年1月1日至2021年12月31日期间接受ERCP手术的所有儿科和成年患者。在此期间,该科室系统调查了所有SSI病例。共进行了8878例外科手术。SSI发生率为0.34%。对30例SSI(19例女性,11例男性)进行了调查,平均年龄为56岁(无儿科患者)。27例患者患有合并症。手术指征包括17例皮肤癌、7例减肥手术、4例乳房重建、1例脂肪瘤、1例漏斗胸。11例手术为淋巴结手术(8例前哨淋巴结,3例清扫)。平均手术时间为116分钟。19例患者接受了抗生素预防。术后SSI发病的平均时间为10天。最常见的细菌是皮肤菌群和消化道的共生菌。除了手术处理外,100%的患者接受了抗生素治疗。高龄、多种合并症、长时间联合手术、设备放置、淋巴结手术、植入设备的术后穿刺等都是SSI的危险因素。在我们科室实施SSI的系统监测为我们提供了实时分析数据的机会,并使我们能够在必要时调整我们的做法。这个过程可用于其他整形重建及美容外科科室。SSI的收集和分析既容易进行,程序也很规范。操作卫生团队的协助是该项目成功的关键资产。在国家层面开展这类程序可能有助于利用更多中心的经验来改善SSI的管理。