Surgical Site Infections in Major Head and Neck Surgeries Involving Pedicled Flap Reconstruction

Goyal, Neerav; Yarlagadda, Bharat B.; Deschler, Daniel G.; Emerick, Kevin S.; Lin, Derrick T.; Rich, Debbie L.; Rocco, James W.; Durand, Marlene L.

doi:10.1177/0003489416672871

Cited by 25 publications

(33 citation statements)

References 21 publications

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“…Groups were comparable in 14 studies. Five articles showed that patients were significantly younger in the FF group compared to PF ( p < 0.05) [10–14]. Gender representation was similar between both groups in the 20 studies reporting gender, as one study [15] showed fewer males in the FF group (70.8% vs 100%, p < 0.05) and another [16] showed fewer males in the PF group (88% vs 32%, p < 0.05).…”

Section: Resultsmentioning

confidence: 99%

“…Prior head and neck surgery was reported in 4 studies. Two studies [10, 17] found there was a lower proportion of patients who had prior head and neck surgery in the FF group compared to the PF group (32% vs 59 and 14% vs 31%, p < 0.05). One study [12] reporting the incidence of preoperative systemic disease showed a lower regrouped incidence of diabetes, cardiovascular disease and hypertension in the FF group (25% vs 83%, p < 0.05).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Free versus pedicled flaps for reconstruction of head and neck cancer defects: a systematic review

Gabrysz-Forget

Tabet

Rahal

et al. 2019

J of Otolaryngol - Head & Neck Surg

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ObjectiveThe present review focuses on comparative studies of reconstruction with free flaps (FF) versus pedicled flaps (PF) after oncologic resection.MethodA systematic review was developed in compliance with PRISMA guidelines and performed using the Pubmed, Medline, EMBASE, Amed and Biosis databases.ResultsA total of 30 articles were included. FF are associated with a longer operative time, a higher cost and a higher incidence of postoperative revisions compared to PF. FF are associated with a longer stay at the intensive care unit than the supraclavicular artery island flap (SCAIF) and with a more extended hospital stay compared to the submental island flap (SMIF). FF are associated with fewer infections and necrosis compared to the pectoralis major myocutaneous flap (PMMF).ConclusionThe comparison of both type of flaps is limited by the inherent design of the studies included. In sum, FF seem superior to the PMMF for several outcomes. SMIF and SCAIF compare favorably to FF for some specific indications achieving similar outcomes at a lower cost.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Free versus pedicled flaps for reconstruction of head and neck cancer defects: a systematic review

Gabrysz-Forget

Tabet

Rahal

et al. 2019

J of Otolaryngol - Head & Neck Surg

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“…Patients undergoing clean-contaminated head and neck surgery are at risk of developing postoperative complications: surgical wound infections, fistula formation, flap dehiscence, and donor site infection, all increasing hospital stay, morbidity, and mortality [5,9]. In preparing this review, we found a wound infection rate after clean-contaminated head and neck surgery ranging between 2.5% and 64%, and polymicrobial in origin [6, 16-18, 27, 28, 35, 37-40].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background: The optimal evidence-based prophylactic antibiotic regimen for surgical site infections following major head and neck surgery remains a matter of debate. Methods: Medline, Cochrane, and Embase were searched for the current best evidence. Retrieved manuscripts were screened according to the PRISMA guidelines. Included studies dealt with patients over 18 years of age that underwent clean-contaminated head and neck surgery (P) and compared the effect of an intervention, perioperative administration of different antibiotic regimens for a variable duration (I), with control groups receiving placebo, another antibiotic regimen, or the same antibiotic for a different postoperative duration (C), on surgical site infection rate as primary outcome (O) (PICO model). A systematic review was performed, and a selected group of trials investigating a similar research question was subjected to a random-effects model metaanalysis.

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“…In terms of type of surgical closure, our study showed that patients with reconstruction were more likely to develop postoperative SSI. Similarly, this was reported in another study where reconstruction surgery was associated with increased risk of postoperative SSI, length of hospitalization stay (LOS), occurs in older patients who were likely to have neoadjuvant radiotherapy and methicillin-resistance staphylococcus aureus (MRSA) positive results [6,11]. We did not review the MRSA status of the patients in this study.…”

Section: Discussionmentioning

confidence: 84%

Effectiveness of a Screening Tool for Early Identification of Malnutrition in Patients with Head and Neck Cancer

Chua

Turner

Iyer

et al. 2019

SN Compr. Clin. Med.

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The purpose of this study was to evaluate the impact of the Malnutritional Universal Screening Tool (MUST) assessment on effects of postoperative surgical site infection (SSI) and length of hospitalization stay (LOS) for patients undergoing oncologic resection for head and neck cancers. A pre-posttest design was used to evaluate the effects of preoperative nutritional screening on postoperative SSI and LOS rates in patients undergoing oncologic resection. A purposive sampling was used to recruit participants for the study. Pre-and post-implementation data were collected over a period of 8 weeks. All patients in the postimplementation group were assessed using the MUST and pre-surgery nutritional optimization was instituted. All participants were monitored for incidences of SSI until discharge. Of the 36 patients in the post-implementation group, 23(63.9%) had a MUST score of moderate to high and 13 (36.1%) had a score of low risk. There was a statistical significance observed between the pre-and post-implementation groups, with both postoperative surgical site infection (SSI) reduced from 50% to 22% and length of hospitalization stay from 28 to 17 days (p = 0.014) between the groups. Patients who were non-smokers (p = 0.010) and without reconstruction after surgery (p = 0.007) were less likely to develop postoperative SSI. Use of the MUST for preoperative nutritional screening has demonstrated that it is a feasible and easy to implement tool for assessment of malnutrition and it has demonstrated positive outcomes in reduction of both postoperative SSI and length of hospitalization stay.

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Surgical Site Infections in Major Head and Neck Surgeries Involving Pedicled Flap Reconstruction

Abstract: The SSI rate following pedicled flap surgeries was low and similar to free flap surgeries despite a significantly different population. No specific risk factors were associated with developing a pedicled flap SSI.

Cited by 25 publications

References 21 publications

Free versus pedicled flaps for reconstruction of head and neck cancer defects: a systematic review

Free versus pedicled flaps for reconstruction of head and neck cancer defects: a systematic review

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

Effectiveness of a Screening Tool for Early Identification of Malnutrition in Patients with Head and Neck Cancer

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