• Cyrill Pfammatter, Jan Hambrecht, Yannik Kalbas, Valentin Neuhaus, Christian Hierholzer, and Claudio Canal.
• Department of Traumatology, University Hospital Zurich, Zurich, 8091, Switzerland. cyrill.pfammatter@bluewin.ch.
• Eur J Trauma Emerg Surg. 2025 Feb 7; 51 (1): 9494.

BackgroundThe use of preoperative antibiotic prophylaxis (POAP) in elective implant removal (IR) is controversial due to a lack of evidence-based recommendations. First-generation cephalosporins, which are commonly used in orthopedic IR, are believed to reduce wound infection risks. However, the potential for serious side effects had raised concerns about their necessity. This study was intended to evaluate whether omitting POAP in small IR increases the risk of wound infections.MethodsThis retrospective, single-centre cohort study was conducted at a level I trauma centre in Switzerland, including patients who underwent IR between January 1, 2016, and December 31, 2021. The IR procedures involved the upper extremities (UEs), such as the clavicle, olecranon, radius and ulna, as well as the lower extremities (LEs), such as the patella, tibia, fibula, (bi)malleolar and foot. Postoperative follow-up included clinical and radiological evaluations 6 weeks after surgery. The outcomes assessed were deep wound infections, wound healing complications, refractures, persistent pain, bleeding, neurovascular injuries and muscle hernias.ResultsOf the 273 patients (mean age: 42.1 ± 14.5; 44% female), 117 (42.9%) received POAP. In the LE group (n = 141), 51.1% received POAP; in the UE group (n = 132), 34.1% received POAP. Eleven (4.0%) wound-healing disorders were documented, with five (4.3%) in the POAP group and six (3.8%) in the non-POAP group (p = 1). No deep wound infections were observed.ConclusionWithholding POAP in elective IR procedures does not significantly increase wound infection rates, suggesting it may be unnecessary in uncomplicated cases.© 2025. The Author(s).

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