Journal of Aesthetic & Reconstructive Surgery

Description

Gender-Affirming Surgery (GAS), also known as genderconfirming or sex reassignment surgery, plays an important role in the transition process for transgender individuals. It can significantly improve the mental health and quality of life for individuals by aligning their physical appearance with their gender identity. However, as with any major surgery, there are inherent risks, with infections being one of the most significant concerns. Infections can lead to complications that may necessitate extended hospital stays, additional surgeries or, in some cases, permanent alterations to the surgical outcome. Therefore, reducing the risk of infections in gender-affirming surgeries is vital for ensuring the success of the procedure and the well-being of the patient. This article analyses the strategies and best practices for reducing infection risks in gender-affirming surgeries.

Preoperative strategies for reducing infection risks

Before proceeding with gender-affirming surgery, a comprehensive assessment of the patient's health and medical history is critical. This includes identifying any underlying conditions such as diabetes, immuno compromised states, obesity or smoking habits that could predispose the patient to infections. Conditions such as diabetes can impair wound healing, while smoking reduces blood flow to tissues, making it more difficult for the body to fight infections. In these cases, optimizing these conditions before surgery, such as better blood glucose control or smoking cessation, is need for minimizing infection risks. One of the most critical steps in preventing infection is preparing the surgical site with proper antiseptic cleaning. This includes the use of broad-spectrum antiseptics like chlorhexidine or iodine-based solutions to reduce bacterial load on the skin. Effective skin sterilization can significantly lower the risk of postoperative infections. In some cases, nasal decolonization using mupirocin ointment may be recommended to eliminate nasal carriage of Staphylococcus aureus, a common pathogen involved in surgical infections.

Prophylactic antibiotics are routinely administered before gender-affirming surgery to reduce the risk of infection. Broadspectrum antibiotics, such as cefazolin or ceftriaxone, are commonly used in the perioperative period to target the most common bacteria that cause surgical site infections. The timing of antibiotic administration is important administering antibiotics within an hour before the incision helps achieve optimal blood concentrations at the time of surgery. A patient’s nutritional status plays a need role in their ability to fight off infections and heal properly after surgery. Malnutrition or poor dietary habits can weaken the immune system, increasing susceptibility to infection. Ensuring that the patient is adequately nourished before surgery is vital. Nutritional assessments should be made and supplementation (such as with vitamin C and zinc) can be considered to improve wound healing.

Intraoperative measures for infection control

A sterile technique is paramount during gender-affirming surgery to reduce the risk of infections. This includes wearing sterile gloves, gowns, masks and using sterile instruments. All surgical staff should adhere to infection control protocols, ensuring that all steps are followed to maintain a sterile field throughout the procedure.

Surgical time is an important factor in reducing infection risks. The longer the surgery lasts, the higher the chance of bacterial contamination. Therefore, minimizing unnecessary delays and optimizing the flow of the procedure can help lower infection risks. Additionally, using advanced surgical technologies, such as minimally invasive techniques, may reduce trauma to tissues and shorten the duration of surgery. Surgical draping is need to maintain a sterile field around the incision site. The use of appropriate drapes and covers prevents the exposure of nonsurgical areas to pathogens, which may otherwise lead to contamination. Proper draping, especially in more extensive surgeries like genital reconstruction, is need to ensuring a sterile environment throughout the operation.

Gender-affirming surgeries vary based on the individual’s needs and can include procedures such as breast augmentation, genital reconstruction (vaginoplasty or phalloplasty), facial surgeries and body contouring procedures. Each of these surgeries involves different anatomical areas, which inherently carry different infection risks. Infections can be classified into two categories: Superficial infections affect the skin and surrounding tissues and usually involve mild symptoms like redness, warmth and tenderness at the surgical site. While these can often be treated with antibiotics, they can lead to delays in healing or poor cosmetic outcomes. Deep infections involve deeper tissues and structures and can have more serious consequences, such as abscess formation, prosthesis rejection and even sepsis. Deep infections may require more intensive medical intervention and can compromise the surgical results.

Infection risks can be increased by factors such as the patient's pre-existing medical conditions, surgical technique, post-operative care and adherence to preventive measures. Identifying these risks and proactively addressing them is need for reducing the likelihood of complications.