The role of the plastic surgeon in the management of surgical infection

At our Medical Center, our reconstructive service has actively sought refer rals of acute and chronic infections by declaring,a an interest in undertak ing the integrated management and reconstruction of these cases. The practices of the two senior surgeons were reviewed for three academic y ears (1992 to 1995), Cases of surgical infection were analyzed as to site, ablative procedures, and reconstructive procedures. In total, 139 patients with 147 infections were identified. Sites of infect ion included head and neck (9.5 percent), trunk and pelvis (39.5 percent), upper extremity (22 percent), and lower extremity (29 percent). One-hundred thirty-one ablative procedures were done on this group, as were 126 reconstructive procedures, including 17 fasciocutaneous flaps, 26 pedi cled muscle flaps, and 28 microsurgical flaps. With a mean follow-up of 14 months, 92 pel cent of these patients had resol ution of infection. The 8 percent failure group included recurrences, amput ation, and death. This series demonstrates that a plastic surgery service can attract a diver se population of surgical infections and manage them successfully with abla tion and a wide variety of reconstructive procedures. The coordination of a blation and reconstruction may be optimally performed by the plastic surgeo n.