PURPOSE: The use of antibiotic prophylaxis in plastic surgery is increasing, and unfortunately is based on anecdotal evidence including case series and retrospective reviews. Lack of data from prospective randomized controlled trials (PRCT) in directing antibiotic use will lead to increased antimicrobial resistance, adverse medication reactions and increased health care expenditures.

METHOD: An in-depth review of the plastic surgery literature was conducted using the PubMed and Ovid MEDLINE databases, between 1966 and the second week of January 2006. A specific search of non-indexed periodicals was also completed. A total of 145 articles were identified using the following keywords: antibiotic, antimicrobial, prophylaxis, plastic surgery. Of these, forty-six articles were identified to be relevant based on established criteria. A scoring system was created to evaluate the pertinence of each study based on a number of factors by a committee of plastic surgeons.

RESULTS: The results were stratified by anatomical category and by level of evidence. To date, there are ten studies (21,7%) evaluating the use of antimicrobial prophylaxis in large PRCT (n > 100). Of these, seven trials (70%) evaluate its use in hand surgery. Expert opinion and surveys account for the majority (23,9%) of the published literature on antimicrobial prophylaxis in plastic surgery.

CONCLUSION: We present the first complete review of antimicrobial prophylaxis in plastic surgery. The lack of evidence-based data and excessive use of antimicrobials in the clinician's practice demonstrate the urgency for further PRCT in guiding prophylactic antibiotic use.