Response to “Perioperative Antibiotics in the Setting of Microvascular Free Tissue Transfer: Current Practices”

We appreciate the thoughtful commentary offered regarding antibiotic administration policies, microbiology, and outcome. We agree that C-reactive protein (CRP) is not a reliable indicator of infection following microvascular free tissue transfer, as CRP is an acute-phase reactant and thus would be expected to increase in the postsurgical milieu. This was impressively quantified by the authors in their “Letter to the Editor.”

Furthermore, as the authors clearly demonstrate, no single microbiological species has yet been identified as a predictor of free flap loss, which renders antibiotic selection for empiric perioperative administration far more complicated.

In conclusion, we agree that there is a dire need for randomized, prospective studies to definitively delineate the most appropriate and efficient selection and duration of perioperative antibiotics in the setting of free tissue transfer so that we may more effectively care for our complex reconstructive patients.