Abstract

Objectives: After this session, participants will understand the current challenges and opportunities in standardizing perioperative incisional care for Class 1 clean wounds in plastic surgery. They will gain insight into how practice variability, evolving national and international guidelines (CDC, WHO, NIH), and FDA regulatory considerations shape current protocols. Learners will be equipped to evaluate and apply evidence-based strategies that improve outcomes, reduce complications, and support consistency across diverse practice settings. Introduction: Despite its importance in preventing surgical site infections and optimizing cosmetic outcomes, incisional care in plastic surgery lacks standardized, specialty-specific guidelines. Current recommendations from organizations like the CDC, WHO, NIH, and ASPS often conflict, leading to significant practice variability. This narrative review addresses that gap by synthesizing high-level evidence, including analysis of national and international guidelines, GRADE-based evidence scoring, and expert consensus to develop actionable strategies for Class 1 clean wound management. Materials / method: A narrative review was conducted using comprehensive searches in PubMed, MEDLINE, and Embase through April 2025. Included sources were randomized controlled trials, systematic reviews, meta-analyses, and official guidelines from CDC, WHO, NIH, and ASPS. Studies focused on Class 1 clean surgical wounds in plastic surgery. The quality of evidence was graded using the GRADE system, and expert consensus was used to establish six best-practice recommendations spanning antiseptics, closure, dressings, and topical care. Results: Six key recommendations were made: (1) Use 4–5% alcohol-based chlorhexidine (CHG) to reduce SSIs. (2) Prefer CHG or povidone-iodine irrigation over saline; avoid routine antibiotic irrigation. (3) Use standard over antimicrobial sutures; barbed sutures and dermal staplers may aid speed but depend on surgeon preference. (4) Choose closure strips/adhesives by wound tension. Use caution with 2-octyl-cyanoacrylate due to the risk of hypersensitivity reactions. (5) Use ciNPWT for high-risk/infected wounds, traditional dressings otherwise. (6) Prefer plain petrolatum over antibiotic ointments. Conclusion: Implementing these six targeted, evidence-backed practices enables plastic surgeons to optimize incisional care, reduce postoperative complications, and improve cosmetic and functional outcomes. Standardizing perioperative protocols can reduce surgical site infections, limit unnecessary antibiotic use, enhance healing, and streamline resource use. These recommendations should inform clinical practice guidelines, residency education, and quality improvement programs across the field of plastic surgery.