Cosmetic Dermatology and Hair Care

Background: With limited published research studying the effect of antibiotic prophylaxis on surgical site infection (SSI) in dermatologic surgery there is no consensus for its use in higher risk cases. Objective: The aim of this prospective double-blinded, randomized, placebo-controlled trial was to determine whether a single oral pre-operative antibiotic dose would significantly reduce SSI following flap and graft dermatologic closures on the nose and ear. Methods: 154 eligible participants in a primary care skin cancer clinic in North Queensland, Australia were randomized to 2g oral cephalexin or placebo 40-60 minutes prior to skin incision. Results: Overall 8/69 (11.6%) controls and 1/73 (1.4%) in the intervention group developed SSI (P=0.015; absolute SSI reduction 10.2%; NNT for benefit 9.8, 95% CI 5.5, 45.5).  In males 7/ 44 controls 0/33 in the intervention group developed SSI (P=0.018; absolute SSI reduction 15.9%; NNT for benefit 6.3, 95% CI 3.8, 19.2).   SSI was much lower in female controls (1/25) and antibiotic prophylaxis did not further reduce this (P=1.0).  There was no difference between the study groups in adverse symptoms attributable to high dose antibiotic administration (P=0.871) Conclusion: A single oral 2g dose of cephalexin given before complex skin closure on the nose and ear reduced SSI.