The value of perioperative antibiotics on the success of oral free flap reconstructions

Abstract

The subject of the presented study was to monitor and compare problems and outcomes of reconstructive surgery with microvascular free flaps in the head and neck region between groups of patients treated with perioperative antibiotics and a group of patients without antibiotics. Patients requiring oral reconstructive surgery following cancer resections with microvascular free flaps were prospectively evaluated (2007-2012). Antibiotic therapy was started 30 min before the operation and administered for 10 days. Three hundred and fifty patients were included (208 male, 59.4%; 142 female, 40.6%; mean age 59.8 ± 13.2 years). 330 patients received perioperative antibiotics. Twenty patients (5.7%) who received no antibiotics for specific reasons served as the control group. Wound infections developed in 33 of 122 patients (27%) who received benzylpenicillin, 17 of 88 patients (19.3%) who received amoxicillin combined with sulbactam and 25 of 120 patients (20.8%) who received cefuroxime. Ten patients (50%) who did not receive antibiotics developed wound infections. Receiving no antibiotics or penicillin showed no benefit (P = 0.11). Those receiving cefuroxime showed significantly lower incidence of wound infections (P = 0.034; risk decreased by the factor 2.88). The use of amoxicillin combined with sulbactam showed the lowest rate of wound infections (P = 0.018; risk decreased by the factor 3.46). The use of amoxicillin combined with sulbactam appears to be the most appropriate prophylactic antibiotic followed by cefuroxime in oral microsurgical free flap reconstructions. These data may serve as a guide until a controlled multicenter prospective trial is performed comparing newer antibiotics against current standards.

Analysis of Risk Factors for Unplanned Reoperation Following Free Flap Surgery of the Head and Neck

“…Additional factors found to be independently associated with unplanned reoperation, such as prior wound infection, surgical site infection, and prolonged ventilation, are also consistent with previous literature as being related to free flap complications . Furthermore, another important finding from our study is the lack of significant association of reoperation with ASA classification.…”

Antibiotic prophylaxis in clean‐contaminated head and neck cases with microvascular free flap reconstruction: A systematic review and meta‐analysis

“…These risk factors include a higher patient American Society of Anesthesiologist score, increased duration of surgery, increased tendency for intraoperative blood loss, and increased preoperative T classification, which can increase surgical invasiveness and postoperative soft tissue dead space . Most clinicians agree that antibiotic prophylaxis should be administered perioperatively in head and neck clean‐contaminated free‐flap cases, with studies demonstrating a significantly increased risk of surgical site infection when prophylactic antibiotics are not administered . However, there is a lack of clinician agreement on the optimal duration of antibiotic prophylaxis in these cases.…”

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

“…Different patient-related factors can increase the risk of SSIs. Diabetes [10,18,19], increased body mass index (BMI) [10,[19][20][21], malnutrition [21,22], anemia [10,21], and elevated American Society of Anesthesiologists (ASA) score [23,24] are associated with an increased risk of infection. Two studies [10,25] also identify undertreated hypothyroidism as a risk factor, whereas another study does not [19].…”