LAUSR

In their paper entitled, ‘‘Predicting risk of infection after rhinoplasty with autogenous costal cartilage,’’ the authors looked at risk factors that contributed to infection [1]. They looked at 672 patients who underwent open rhinoplasty using costal cartilage grafting performed by three surgeons. The patients were routinely treated with postoperative antibiotics as well. Positive bacterial culture was the parameter used to document infection. The authors noted an infection rate of 5.36% with the most common pathogens being Enterobacter cloacae (11 patients), Staphylococcus aureus (11 patients), Escherichia coli (8), Coagulase-negative Staphylococcus (7) and Methicillinresistant Staphylococcus aureus (3). The authors found that factors contributing to infection included; age, number of nose operations, length of hospital stay, operation time, history of nose trauma, history of animal contact, spicy food within one month after the operation, smoking within one month after operation, drinking within one month after operation, and prior history of infection. Interestingly, the authors found eating spicy food within one month after the operation was the most important factor in predicting infection. The description of spicy foods can have many connotations. The authors defined spicy foods ‘‘as dishes or food made with chili peppers, onions, garlic, ginger, and mustard.’’ They imply the key ingredient in ‘‘spicy foods’’ would be the chili peppers. They refer to the capsaicin in spicy foods as the major culprit that ‘‘can trigger a series of inflammatory events and release pro-inflammatory mediators by activating small diameter C fibers.’’ In fact, there is an abundance of literature on the ‘‘anti-inflammatory benefits of capsaicin’’ [2–6]. The authors also note, ‘‘many spice food in Asia contains more sugar and oil, making food more delicious.’’ It is more likely that the sugars in the spicy foods acted to trigger inflammation, and could contribute to infection. Sugars and simple carbohydrates are highly inflammatory and trigger inflammation in the body [7–12]. Simple carbohydrates include foods such as bread, pasta, potatoes, and rice. Many Chinese patients likely also had a high white rice intake as well as other simple carbohydrates that can also contribute to chronic inflammation [13]. Diabetics tend not to heal as well postoperatively and have a higher incidence of infection after surgery [14]. Studies have also shown that lower blood sugar levels are associated with lower postoperative infection rates [15, 16]. Considering the effects of sugars and simple carbohydrates, the increased infections in this population could be related to a diet that is higher in sugar and simple carbohydrates, and not due to the intake of capsaicin in the foods. I have studied the effects of diet on postoperative healing in rhinoplasty for many years. I place all of my rhinoplasty patients on an anti-inflammatory diet with no sugars and very low intake of simple carbohydrates such as bread, pasta, potatoes and rice [17]. I can clearly see that the patients on an anti-inflammatory diet heal with less postoperative edema and less erythema. We also have very low infection rates that is also likely affected by our postoperative infection prevention regimen [18]. This & Dean M. Toriumi [email protected]