Antibiotic‐Loaded Calcium Sulphate Beads in Wound Management: A Scoping Review of Emerging Applications in Plastic and Reconstructive Surgery

ABSTRACT

Calcium sulphate (CS) is a fully synthetic, sterile, bioabsorbable biomaterial extensively applied for the management of infected tissues and postoperative dead spaces resulting from surgical interventions. Residual DS may facilitate hematoma accumulation and bacterial colonisation, thereby heightening the risk of surgical-site infections. Within orthopaedic surgery, CS has been predominantly evaluated as a bone-void filler and an off-label antibiotic delivery vehicle—particularly in arthroplasty revisions, chronic osteomyelitis, and open fractures—yielding high rates of infection prophylaxis, bone regeneration, and low complication profiles. Commercially available as injectable ‘pearls’ or beads, CS permits local, sustained antibiotic elution while undergoing gradual biodegradation, thus obviating the need for secondary removal procedures. Over the last decade, Calcium Sulphate beads (CSBs) have transcended orthopaedics, gaining traction across general, vascular, and endocrine surgery disciplines for the prevention and treatment of complex wound infections. However, their application in plastic and reconstructive surgery remains underreported, despite the specialty's frequent engagement with complex soft-tissue defects, bone exposure, suture dehiscence, and trauma-related wounds vulnerable to infection. To our knowledge, this represents the first scoping review synthesising current evidence, clinical indications, and emerging roles of CSBs within plastic and reconstructive surgery.