The time course and microbiology of surgical site infections after head and neck free flap surgery

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

doi:10.1002/lary.25038

Cited by 54 publications

(61 citation statements)

References 40 publications

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“…A mean 15 day interval was noted (range = 6–26 days) before diagnosis of donor site surgical site infection was made. We have previously described the time of onset and microbiology of these donor surgical site infections . No statistically significant associations were noted between the development of donor site surgical infection and the flap harvest site or applicable as previously described independent variables, including ASA, age, and surgical duration.…”

Section: Resultsmentioning

confidence: 91%

“…Twenty‐two of the 64 patients (34.4%) with surgical site infection developed late‐onset surgical site infections (days 15–30 postoperatively), but there was no significant difference in any of the patient or operative characteristics noted above when comparing this group with the early onset (days 1–14 postoperatively) surgical site infection group ( p > .05; chi‐square for categorical variables; Student's t test for continuous variables). We have previously described the time course and microbiology of surgical site infections in a cohort that included the 64 surgical site infections described in this study …”

Section: Resultsmentioning

confidence: 99%

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Head and neck free flap surgical site infections in the era of the Surgical Care Improvement Project

et al. 2015

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Head and neck free flap surgical site infections in the era of the Surgical Care Improvement Project

et al. 2015

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“…Infections of the head and neck following ablative surgery may lead to bacterial colonization of plates, resulting in biofilm formation, wound contamination and subsequent plate exposure requiring hardware removal to eliminate the nidus of infection [32]. Durand et al recently reviewed their experience of SSIs following head and neck free reconstructive surgeries reporting 25% of their swabs growing normal oral flora, 44% gram-negative bacilli, 20% methicillin-resistant Staphylococcus aureus and 16% methicillin-sensitive Staphylococcus aureus [33]. The authors found that in 67% of cultures, at least one pathogen was found to be resistant to prophylactic antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure

Yao

Ziai

Tsang

et al. 2017

J of Otolaryngol - Head & Neck Surg

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BackgroundPlate-related complications following head and neck cancer ablation and reconstruction remains a challenging problem often requiring further management and reconstructive surgeries. We aim to identify an association between surgical site infections (SSI) and plate exposure.MethodsA retrospective study between 1997 and 2014 was performed to study the association between postoperative SSI and plate exposures. Eligible patients included those with a history of oral squamous cell carcinoma who underwent surgical resection, neck dissection, and free tissue reconstruction. Demographic and treatment related information was collected. SSI were classified based on CDC definition and previously published literature. Univariable analysis on demographic factors, smoking history, diabetes, radiation, surgical and hardware related factors; while multivariable analysis on SSI, plate height, segmental mandibulectomy defects and radiation were conducted such as using cox proportional hazard models.ResultsThree hundred sixty-five patients were identified and included in our study. The mean age of the study group was 59.2 (+/−13.8), with a predominance of male patients (61.9%). 10.7% of our patient cohort had diabetes, and another 63.8% had post-operative radiation therapy. Patients with SSI were more likely to have plate exposure (25 vs. 6.4%, p <0.001). Post-operative SSI, mandibulectomy defects, and plate profile/thickness were associated with plate exposure on univariable analysis (OR = 5.72, p < 0.001; OR = 2.56, p = 0.014; OR = 1.44, p = 0.003 respectively) and multivariable analysis (OR = 5.13, p < 0.001; OR = 1.36, p = 0.017; OR = 2.58, p = 0.02 respectively).ConclusionSurgical site infections are associated with higher rates of plate exposure. Plate exposure may require multiple procedures to manage and occasionally free flap reconstruction.

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“…Several studies show an association between previous radiotherapy and increased risk of SSI, 64,65,69,144,145,147,149 being worse in patients exposed to irradiation doses greater than 60 Gy. 144,145 Suh et al found an association between previous surgery and the risk of developing SSI.…”

Section: Is Antibiotic Prophylaxis Required For Clean-contaminated mentioning

confidence: 99%

Systematic review of international guidelines for perioperative antibiotic prophylaxis in Head & Neck Surgery. A YO‐IFOS Head & Neck Study Group Position Paper

et al. 2019

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Background Surgical site infection (SSI) is defined as an infection that occurs after a surgical incision or organ manipulation during surgery. The frequency reported for clean head and neck surgical procedures without antimicrobial prophylaxis is <1%. In contrast, infection rates in patients undergoing complicated cancer surgery are high, ranging from 24% to 87% of patients without antimicrobial prophylaxis. Methods Guidelines and recommendations about the use of antibiotics in head and neck surgery from 2004 to 2019 were reviewed. Results Four guidelines from Oceania, 5 from South America, 5 from North America, 2 from the United Kingdom, 11 from Europe, 1 from Africa, 1 from the Middle East, and 3 from Asia were included. A total of 118 papers were included for analysis and recommendation. Conclusion Antibiotic prophylaxis can decrease the incidence of SSI. However, the risks associated with antibiotic exposure and the risk of antibiotic resistance need to be taken into consideration.

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The time course and microbiology of surgical site infections after head and neck free flap surgery

Abstract: 2b

Cited by 54 publications

References 40 publications

Head and neck free flap surgical site infections in the era of the Surgical Care Improvement Project

Head and neck free flap surgical site infections in the era of the Surgical Care Improvement Project

Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure

Systematic review of international guidelines for perioperative antibiotic prophylaxis in Head & Neck Surgery. A YO‐IFOS Head & Neck Study Group Position Paper

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