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

Objective: To evaluate surgical site infections (SSI) after pedicled reconstruction in head and neck surgery. Methods: Records of patients with pedicled flap reconstructions between 2009 and 2014 at Massachusetts Eye and Ear were reviewed. Onset of SSI or fistula ≤30 days postoperatively was noted....

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Bibliographic Details
Published in:Annals of otology, rhinology & laryngology rhinology & laryngology, 2017-01, Vol.126 (1), p.20-28
Main Authors: Goyal, Neerav, Yarlagadda, Bharat B., Deschler, Daniel G., Emerick, Kevin S., Lin, Derrick T., Rich, Debbie L., Rocco, James W., Durand, Marlene L.
Format: Article
Language:English
Subjects:
Aged
Anti-Bacterial Agents - administration & dosage
Antibiotic Prophylaxis
Clindamycin - administration & dosage
Cutaneous Fistula - epidemiology
Head and Neck Neoplasms - surgery
Humans
Length of Stay - statistics & numerical data
Massachusetts - epidemiology
Methicillin-Resistant Staphylococcus aureus
Middle Aged
Operative Time
Otorhinolaryngologic Surgical Procedures
Reconstructive Surgical Procedures
Retrospective Studies
Risk Factors
Staphylococcal Infections - epidemiology
Surgical Flaps - adverse effects
Surgical Wound Infection - epidemiology
Surgical Wound Infection - microbiology
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Summary:Objective: To evaluate surgical site infections (SSI) after pedicled reconstruction in head and neck surgery. Methods: Records of patients with pedicled flap reconstructions between 2009 and 2014 at Massachusetts Eye and Ear were reviewed. Onset of SSI or fistula ≤30 days postoperatively was noted. A free flap cohort was reviewed for comparison. Results: Two hundred and eight pedicled reconstructions were performed for cancer (83%), osteoradionecrosis (7%), and other reasons (10%). Most (72%) cases were clean-contaminated and American Society of Anesthesiologists classification 3 or higher (73%); 63% of patients had prior radiation. The SSIs occurred in 9.1% and were associated with a longer length of stay (P = .004) but no particular risk factors. Seventeen patients developed a fistula (11 without SSI). The SSI rates were not significantly different between pedicled and free flaps, but pedicled flap patients were older, more likely to have had prior surgery and/or radiation, and be methicillin-resistant Staphylococcus aureus positive. In the combined population, multivariate analysis demonstrated clean-contaminated wound classification (P = .03), longer operating time (P = .03), and clindamycin prophylaxis (P = .009) as SSI risk factors. Conclusions: 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.
ISSN:0003-4894
1943-572X
DOI:10.1177/0003489416672871