Infection and chemotherapy: recent experiences, proposed strategies and perspectives in plastic and reconstructive surgery.

In plastic surgery the necessity of avoiding as much septic complication as possible is caused by major technical peculiarities. On the one hand the use of autologous grafts (skin, cartilage, bone, microsurgical flaps, etc.) makes the surgical act prone to infection, even in the case of "clean surgery" with almost total failure. On the other hand, reconstruction is performed in "unclean" and immunodepressed patients such as burned and polytraumatized patients. Finally, there are recent and extensive uses of normal and "smart" and biodegradable biomaterials (from silicon to hyaluronic acid esters, etc.) and particularly the recent possibility of applying the products of tissue engineering (cultured fibroblasts, cheratinocyte, chondrocytes grown and expanded in vitro on various scaffolds) with the known increase in infectious risks, has made mandatory the prevention and treatment of infections and also the identification of the "local" environmental increase in resistant strains. A brief review is presented together with the results of the Italian Multicenter Burns Antibiotic Protocol on more than 300 patients and the data on 284 patients treated with auto-semi-artificial skin expanded in vitro at the Institute of Plastic Surgery of the University of Milan Medical School.