What is the treatment for infections at the incision site after an abdominoplasty (tummy tuck)?

From the Guidelines

Treatment for infections at the incision site after an abdominoplasty should involve suture removal plus incision and drainage, with adjunctive systemic antimicrobial therapy considered for significant systemic responses, as recommended by the Infectious Diseases Society of America 1. The goal of treatment is to prevent complications like wound dehiscence, delayed healing, or more serious systemic infection, while also minimizing morbidity, mortality, and improving quality of life. Key considerations in managing these infections include:

• Prompt evaluation by the surgeon who performed the procedure
• Use of oral antibiotics, such as cephalexin, amoxicillin-clavulanate, or trimethoprim-sulfamethoxazole, for 7-14 days depending on infection severity
• Proper wound care, including gentle cleaning with sterile saline, application of antibiotic ointments, and regular dressing changes using sterile technique
• Potential need for intravenous antibiotics or hospitalization for more serious infections
• Monitoring for signs of worsening infection, such as spreading redness, increased pain, fever, or purulent discharge Recent guidelines also suggest considering the use of antibiotic-coated sutures to prevent surgical site infections, particularly in emergency settings 1. However, the use of retention sutures is not universally recommended and may be considered on a case-by-case basis for patients with high-risk factors for wound complications 1. Overall, a comprehensive approach to managing infections after abdominoplasty is crucial to optimize patient outcomes and minimize the risk of complications.

From the FDA Drug Label

To prevent postoperative infection in contaminated or potentially contaminated surgery, recommended doses are: 1 gram IV or IM administered 1/2 hour to 1 hour prior to the start of surgery. For lengthy operative procedures (e.g., 2 hours or more), 500 mg to 1 gram IV or IM during surgery (administration modified depending on the duration of the operative procedure). 500 mg to 1 gram IV or IM every 6 to 8 hours for 24 hours postoperatively

The treatment for infections at the incision site after an abdominoplasty (tummy tuck) may include cefazolin. The dosage is:

• 500 mg to 1 gram IV or IM every 6 to 8 hours for 24 hours postoperatively 2 Key points:
• The prophylactic administration of cefazolin may reduce the incidence of certain postoperative infections in patients undergoing surgical procedures which are classified as contaminated or potentially contaminated.
• The perioperative use of cefazolin also may be effective in surgical patients in whom infection at the operative site would present a serious risk.
• If there are signs of infection, specimens for cultures should be obtained for the identification of the causative organism so that appropriate therapy may be instituted 2

From the Research

Treatment for Infections at the Incision Site after Abdominoplasty

• The treatment for infections at the incision site after an abdominoplasty (tummy tuck) typically involves antibiotic therapy, with the specific approach depending on the severity of the infection 3.
• For mild infections, prompt treatment with surgical drainage and a short-term course of broad-spectrum antibiotics, such as ampicillin/sulbactam or cefoxitin, is recommended 3.
• For more severe infections, a combination of antibiotics covering anaerobes, Gram-negative rods, and Gram-positive cocci, including MRSA and VRE, may be necessary 3.
• The use of prophylactic antibiotics in abdominoplasty operations has been shown to reduce the incidence of postoperative wound infections, with a single preoperative dose of intravenous antibiotic recommended 4.
• However, the effectiveness of pre-incisional antibiotics in reducing surgical site infections (SSIs) in emergency appendectomies has been questioned, with some studies suggesting that additional pre-incisional antibiotics may not be beneficial in patients who have already received broad-spectrum antibiotic treatment 5.
• The antimicrobial management of intra-abdominal infections, including SSIs, requires a delicate balance between optimizing empirical therapy and reducing unnecessary use of antimicrobials to minimize the risk of antimicrobial resistance 6.
• Abdominal SSIs are a significant global health problem, and a practical approach to their treatment, including the use of antimicrobial therapy, is essential to improve outcomes 7.