Risk Factors for Surgical Site Infection in Patients Undergoing Free and Pedicled Myocutaneous Flap Reconstruction After Oral Cancer Resection

Makiguchi, Takaya; Yokoo, Satoshi; Kanno, Yuki; Kurihara, Jun; Suzuki, Keisuke

doi:10.1016/j.joms.2018.12.028

Cited by 10 publications

(9 citation statements)

References 29 publications

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“…Patients with oral cancer are likely to have poor nutrition from before surgery, and this may be a reason for the high incidence of postoperative SSI after surgery, in addition to the dead space that may be formed anatomically and exposure of the wound to saliva and fluid in the oral cavity (Belusic‐Gobic et al, ; Hirakawa et al, ; Kamizono et al, ; Karakida et al, ; Lee et al, ; Liu et al, ; Makiguchi et al, ; Ogihara et al, ; Yang et al, ). Use of a free flap that is well vascularized is common for reconstruction of a large or complex defect after extended resection of oral cancer, but SSI may occur more frequently in this procedure (Makiguchi et al, ; Ogihara et al, ). In this study, we identified risk factors for SSI in oral cancer resection surgery with free flap reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the above recommendations, postoperative antibiotics are often maintained at the clinician's discretion, with many clinicians administering prophylactic antibiotics for >24 hr (and for >7 days in some hospitals; Haidar et al, ; Saunders et al, ; Mitchell et al, ; Reiffel et al, ). We still use a relatively long period of antibiotic administration for free flap surgery after oral cancer resection because the frequency of SSIs in these surgeries is high compared with other clean‐contaminated surgeries, especially in extended surgery with free flap reconstruction (Makiguchi et al, ; Ogihara et al, ), although evidence for the benefit of this protocol is still lacking.…”

Section: Discussionmentioning

confidence: 99%

“…Surgery for oral cancer is defined as a clean‐contaminated surgery by the Centers for Disease Control and Prevention (CDC; Mangram, Horan, Pearson, Silver, & Jarvis, ), and reconstruction with a well‐vascularized free flap is standard treatment for a large defect after extended resection of oral cancer (Makiguchi, Yokoo, & Kurihara, ; Markiewicz et al, ; Zhang et al, ). However, the frequency of SSI in oral cancer surgery is high compared with other clean‐contaminated surgeries, especially in extended surgery with free flap reconstruction (Makiguchi, Yokoo, Kanno, Kurihara, & Suzuki, ; Ogihara, Takeuchi, & Majima, ).…”

Section: Introductionmentioning

confidence: 99%

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Impact of skeletal muscle mass volume on surgical site infection in free flap reconstruction for oral cancer

et al. 2019

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Background: Sarcopenia is a disease in which skeletal muscle mass (SMM) and function are progressively lost. Here, we investigate surgical site infection (SSI) as a function of SMM in patients who underwent free flap reconstruction for a defect caused by oral cancer resection.Methods: A nonrandomized, retrospective group of 122 patients treated with free flap reconstruction after oral cancer resection was enrolled in the study. All subjects also underwent preoperative abdominal-lumbar computed tomography (CT). Crosssectional areas (cm 2 ) of skeletal muscles in the L3 region were measured by manual outline on CT images. The obtained areas were normalized for height (cm 2 /m 2 ), and the resulting value is referred to as the skeletal muscle index (SMI).Results: Recipient site SSI occurred in 30 patients (24.6%). Underweight status (body mass index [BMI] < 18.5 kg/m 2 ), anemia and lower SMI were significantly related to recipient site SSI in univariate analysis (p < . 05). In multiple logistic regression analysis, lower SMI was an independent significant risk factor for recipient site SSI (p = .015, adjusted odds ratio = 1.41 per 5 cm 2 /m 2 decrease).Conclusions: These findings suggest that a decrease in SMM might have more impact than a decrease in BMI on SSI in free flap reconstruction after resection of oral cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of skeletal muscle mass volume on surgical site infection in free flap reconstruction for oral cancer

et al. 2019

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“…According to Liu et al, the PMMF is ideally applied for patients with free flap failure, previous RT, or for selected patients not tolerating prolonged surgery [7]. Despite the PMM flap's complication rate, being characterized by a relevant number of partial necrosis and impaired wound healing [8,9], it remains a main option for reconstructive salvage surgery in selected patients. Alternatively-in vessel depleted necks or compromised flaps-studies on temporarily free flap supply by extracorporeal perfusion are currently performed which may present an option in the future although the required resources are tremendous [10].…”

Section: Discussionmentioning

confidence: 99%

A decade of reconstructive surgery: outcome and perspectives of free tissue transfer in the head and neck. Experience of a single center institution

Spoerl

Schoedel

Spanier

et al. 2020

Oral Maxillofac Surg

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Purpose Free flaps have become the standard option in reconstructive surgery of the head and neck. Even though many authors have outlined the reliability of free transplants, there is an ongoing discussion about treatment options for patients bearing particular risks as previous irradiation treatment. In this analysis, we aim to address these patients with particular risk profiles by comparing different flap entity outcome parameters. Methods We retrospectively analyzed a cohort of 494 patients who underwent flap surgery between 2009 and 2018 in our department. Focusing on free microvascular transplants, we additionally analyzed the pectoralis major myocutaneous flap as the most frequently used vascular pedicled flap. Data analysis was performed by uni-and multivariate statistics. Results Overall flap success rate was 90%, with the radial forearm flap occurring to be most reliable (93%) in head and neck reconstruction. Previous radiation therapy (RT) and intraoperative revision of vascular anastomosis during primary surgery significantly resulted in impaired transplant outcome with a success rate of 91.8% (no RT) vs. 83.7% (RT), respectively. There was a negative linear correlation between incision to suture time and number of flaps per year (R 2 = 0.67). Conclusions Preoperative radiation therapy and intraoperative revision of anastomosis significantly impair outcome of microvascular flaps in the head and neck and oral cavity, whereas patient's age is not a predictor of flap failure. Increasing case number and experience reduces time of flap surgery as well as rate of complications and flap failure.

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“…Osteocutaneous flaps (OCF), mostly consisting of free fibular flaps, are increasingly used for mandibular reconstruction after head and neck cancer surgery but also in rarer indications such as benign tumors, mandibular chronic osteomyelitis, radionecrosis/chemonecrosis of the jaw, or posttraumatic reconstruction. This complex technique is associated with a high risk of perioperative complications, reaching 54 % in some studies (Eskander et al, 2018;Suh et al, 2004), and especially a 13 % to 41 % risk of surgical site infection (SSI) (Kamizono et al, 2014;Karakida et al, 2010;Makiguchi et al, 2019;Cannon et al, 2017). This high SSI rate is probably due to the clean-contaminated surgical field with intrabuccal exposure.…”

Section: Introductionmentioning

confidence: 99%

Osteocutaneous-flap-related osteomyelitis following mandibular reconstruction: a cohort study of an emerging and complex bone infection

Javaux

Daveau²,

Bettinger³

et al. 2022

J. Bone Joint Infect.

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Abstract. Osteocutaneous flap (OCF) mandible reconstruction is at high risk for surgical site infection. This study aimed to describe diagnosis, management, and outcome of OCF-related osteomyelitis. All patients managed at our institution for an OCF-related osteomyelitis following mandible reconstruction were included in a retrospective cohort study (2012–2019). Microbiology was described according to gold-standard surgical samples, considering all virulent pathogens, and potential contaminants if present on at least two samples. Determinants of treatment failure were assessed by logistic regression and Kaplan–Meier curve analysis. The 48 included patients (median age 60.5 (IQR, 52.4–66.6) years) benefited from OCF mandible reconstruction mostly for carcinoma (n=27/48; 56.3 %) or osteoradionecrosis (n=12/48; 25.0 %). OCF-related osteomyelitis was mostly early (≤3 months post-surgery; n=43/48; 89.6 %), presenting with local inflammation (n=28/47; 59.6 %), nonunion (wound dehiscence) or sinus tract (n=28/47; 59.6 %), and/or bone or device exposure (n=21/47; 44.7 %). Main implicated pathogens were Enterobacteriaceae (n=25/41; 61.0 %), streptococci (n=22/41; 53.7 %), Staphylococcus aureus (n=10/41; 24.4 %), enterococci (n=9/41; 22.0 %), non-fermenting Gram-negative bacilli (n=8/41; 19.5 %), and anaerobes (n=8/41; 19.5 %). Thirty-nine patients (81.3 %) benefited from surgery, consisting of debridement with implant retention (DAIR) in 25/39 (64.1 %) cases, associated with 93 (IQR, 64–128) days of antimicrobial therapy. After a follow-up of 18 (IQR, 11–31) months, 24/48 (50.0 %) treatment failures were observed. Determinants of treatment outcomes were DAIR (OR, 3.333; 95 % CI, 1.020–10.898) and an early infectious disease specialist referral (OR, 0.236 if ≤2 weeks; 95 % CI, 0.062–0.933). OCF-related osteomyelitis following mandibular reconstruction represents difficult-to-treat infections. Our results advocate for a multidisciplinary management, including an early infectious-disease-specialist referral to manage the antimicrobial therapy driven by complex microbiological documentation.

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Risk Factors for Surgical Site Infection in Patients Undergoing Free and Pedicled Myocutaneous Flap Reconstruction After Oral Cancer Resection

Cited by 10 publications

References 29 publications

Impact of skeletal muscle mass volume on surgical site infection in free flap reconstruction for oral cancer

Impact of skeletal muscle mass volume on surgical site infection in free flap reconstruction for oral cancer

A decade of reconstructive surgery: outcome and perspectives of free tissue transfer in the head and neck. Experience of a single center institution

Osteocutaneous-flap-related osteomyelitis following mandibular reconstruction: a cohort study of an emerging and complex bone infection

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