Extended use of perioperative antibiotics in head and neck microvascular reconstruction

Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis

“…The UADT harbors a large variety of microorganisms, such as gram-positive and facultative anaerobic bacteria, and to a lesser degree gram-negative bacteria, Candida species, and bacteria originating from an eventually harvested flap [4]. When patients with a compromised condition, undergoing extensive procedures (with a prolonged operation time and use of foreign bodies such as tracheal cannulas), are exposed to this flora, they experience a higher incidence of SSIs [5,6]. In the absence of antibiotic prophylaxis, SSI rate ranges between 24% and 87% in this patient group [7].…”

“…Occurring in 20-50% of these patients, SSIs are associated with increased fistula formation, prolonged hospitalization, increased morbidity and mortality, and reconstruction failure, all resulting in increased healthcare costs. Therefore, the effectiveness of antibioprophylaxis (ABP) of SSIs is a topic of major interest [5,9].…”

Current practices in microvascular reconstruction in otolaryngology–head and neck surgery

“…Furthermore, surgical site infection is a significant risk factor for readmission and free lap failure. Recent studies have shown evidence to support recommendations including use of prophylactic antibiotics for at least the first 24 hours of hospitalization, cautious use of clindamycin, and no benefit to duration greater than 1 week for free flap patients . There is currently no consensus on antibiotic regimen or duration otherwise.…”

“…Many modalities of flap monitoring exist, as well as many institutional schema regarding the optimal timing and responsible providers for flap checks . Anesthetic/sedation plans, appropriate postoperative level of care, duration of postoperative antibiotics, and anticoagulation plans have all been studied, yet no consensus exists for these aspects of patient care following MFTT . Furthermore, perioperative care regimens have not been reliably associated with measures of overall free flap success or complication rates .…”

“…2,8 Anesthetic/sedation plans, appropriate postoperative level of care, duration of postoperative antibiotics, and anticoagulation plans have all been studied, yet no consensus exists for these aspects of patient care following MFTT. 1,[9][10][11][12] Furthermore, perioperative care regimens have not been reliably associated with measures of overall free flap success or complication rates. 1,[13][14][15] Thus, current research is being directed toward optimizing perioperative care protocols.…”