Do systemic antibiotics increase the survival of a full thickness graft on the nose?

Background: Full thickness grafts on the nose do not always heal without problems. Partial or entire necrosis of the graft is likely to lead to less favourable cosmetic results and prolonged wound care. No consensus exists as to the use of systemic antibiotics to increase the success rate of survival of a full thickness skin graft on the nose after non-melanoma skin cancer surgery. Objective: The objective of the study was to evaluate the effect of systemic antibiotics on the survival of full thickness grafts on the nose. Methods: We performed a randomized, controlled trial in which we compared azithromycin with standard treatment in 30 patients, who underwent a full thickness graft reconstruction of a surgical defect on the nose after surgery for non-melanoma skin cancer. Percentage survival of the graft was the main outcome measure. Results: A statistically significant difference in favour of the grafts treated with azithromycin was seen (P = 0.002). Of all the variables analysed, only smoking had a significant negative effect on the survival of the graft. Conclusions: Systemic antibiotics with an accurate bacterial spectrum should be advised in full thickness skin graft reconstruction after surgery for non-melanoma skin cancer of the nose. Smoking should be strongly discouraged.

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