Skin integrity and removal before or after pancreas transplant? Also post op infection prevention?

Question

I have had 2 laparoscopic surgeries, anything to help improve skin integrity? I have to have a gastric sleeve surgery before I get put on the transplant list for a new pancreas. It's to improve my transplant outcome since I have very high insulin resistance (I'm maxed out on Metformin and I take a lot of insulin in my pump but A1c is 6.4). I assume it's better to have skin removal before transplantation? Would doing a bleach bath or using Hibiclens help reduce post op infections?

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding skin removal surgery before or after a pancreas transplant and how to keep the skin as clean as possible before and after the surgery. In regards to keeping the skin as clean as possible before surgery, I routinely have my patients cleanse their skin for three days before surgery with Hibiclens. There are multiple medical studies that show that this decreases postoperative infections. I would also suggest that antibiotics be given through the IV during the surgery, as well as oral antibiotics being given after the surgery. You’re at high risk for infection due to your diabetes and pancreas status. In regards to your surgery for skin removal, it is very important to coordinate with your transplant surgeon. There are risks and benefits to doing the skin removal surgery before as well as after the pancreas transplant. It will be essential to coordinate timing. Thank you for your question regarding skin integrity and whether you should do skin removal surgery before after a pancreas transplant. Good luck.

Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Daniel Barrett, MD · Answer

Dear t1dmpedsnurse,
every plastic surgeon has his own preoperative protocol which he recommends to his patients. I would suggest you to discuss this with your plastic surgeon.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

M. Shuja Shafqat, MD · Answer

Good afternoon,
This is a hard question and one that would have to be discussed between your plastic surgeon and transplant surgeon. It is great that your A1C is 6.4. Typically after your transplant you will be on medications to reduce the risk of rejection. These medications typically also impact wound healing. Therefore, you will be at high risk of major wound healing problems to do a skin removal surgery after your transplant. You also cannot stop the medications to have skin removal because you will be at risk for rejecting your pancreas transplant.
Short answer is, you need to have a plastic surgeon who will work with your transplant surgeon to discuss optimal timing of any surgeries. You should find a board certified plastic surgeon who can examine you in person and discuss all the options. 
Best of luck!

Skin integrity and removal before or after pancreas transplant? Also post op infection prevention?

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Skin integrity and removal before or after pancreas transplant? Also post op infection prevention?

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