To determine the incidence of methicillin-resistant Staphylococcus aureus (MRSA)-positive surgical site infections after face-lift surgery and to discuss the screening, prevention, and treatment of such infections.
The morning of surgery, all patients showered and washed their hair with chlorhexidine solution.After the induction of anesthesia and before incision, the patients' faces were scrubbed with chlorhexidine and povidone-iodine. Attention was placed along the areas of the face-lift incision, including the hair-bearing scalp 5 cm posterior to the hairline.Sterile towels were then secured around the patient's head to sterilely secure the surgical site.Before incision, 1 g of intravenous cefazolin sodium (Ancef) was administered (clindamycin if the patient was allergic to penicillin).After surgery, all patients were given a 7-day prescription for oral cefadroxil (Duricef).The patients were then seen on postoperative days 1, 5, 8 (suture removal), 21, and 40. During each visit, they were examined for any signs of infection, such as erythema and fluid collection.
Those cases with MRSA colonization and no clinical infection were treated with mupirocin (Bactroban) nasal ointment 3 times daily and 2% triclosan (Aquasept) washes twice daily for 5 days.Povidone-iodine (Betadine) mouthwash was also used 2 to 3 times daily as gargle for 5 days. Chlorhexidine mouthwash was used in patients with a contraindication to iodine.
Once MRSA infection is diagnosed after a face-lift, aggressive treatment is advised to prevent rapid progression of the infection. Prompt initiation of appropriate antibiotic therapy, along with incision and drainage, is essential. The cosmetic nature of rhytidectomy may make facial plastic surgeons hesitant to open wounds that have an infected collection. However, openly draining wounds that have collected MRSA-positive material is prudent.…….The facial plastic surgeon must be quick to culture any suspicious fluid or discharge. The result of the sensitivity and resistance profile from these cultures will be the ultimate guide for the antibiotic regimen. Prompt culture cannot be stressed enough. The infection can spread rapidly along the surgical dissection site and become extensive in a very brief time frame. …….
"Methicillin-resistant staphylococcus aureus-positive surgical site infections in face-lift surgery" Arch Facial Plast Surg 2008; 10: 116 – 123; Zoumalan RA, Rosenberg DB