Antibiotic prophylaxis and reconstructive operations in patients with burn sequelae

The results of the clinicolaboratory investigation of the efficacy of antibiotic prophylaxis in 215 patients subjected to reconstructive operations for postburn scars are presented. The biological investigation of the postburn scars revealed the presence of microflora in about half of the patients. The microflora was mainly represented by Staphylococcus aureus and S. epidermidis. The level of the dissemination was not high. Ulcerated scars had higher levels of the bacterial contamination. The pharmacokinetic study of cefazolin, carbenicillin, aztreonam and gentamicin showed that the release of the first three drugs to the scar tissues was good. The clinical observations demonstrated that purulent inflammatory complications developed in patients with risk factors (ulceration of the scar, necrotic foci in the wound, involvement of the oral cavity and nasal passages to the operation), not treated with the antibiotics or treated with the drugs not inhibiting the microflora of the operation wounds (gentamicin, aztreonam). The results permitted to recommend the use of the antibiotic prophylaxis in reconstructive operations only in risk patients with burn consequences. With this purpose it is advisable to use antibiotics satisfactorily penetrating to the tissues of the postburn scars and active against the microflora vegetating in them (cefazolin and carbenicillin).