Surgical Site Infections in Patients receiving Osteomyocutaneous Free Flaps to the Head and Neck. Does Choice of Antibiotic Prophylaxis Matter?

Publication date: Available online 16 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): James Murphy, Amal Isaiah, Donita Dyalram, Joshua E. Lubek
PurposeThe most appropriate prophylactic antibiotic for clean contaminated head and neck osteomyocutameous free tissue transfer procedures is unclear. The purpose of this study is to determine whether choice of perioperative antibiotic was related to recipient surgical site infection (SSI) in subjects receiving an osteomyocutaneous free tissue transfer (OFF) to the head and neck.MethodRetrospective cohort study between July 2010 and October 2013 at a tertiary care medical center to evaluate SSI in relation to perioperative antibiotic received. Minimum follow-up of 6 months. SSI was defined by the Centers for Disease Control and Prevention wound infection criteria. Perioperative antibiotic selected, duration of use, OFF performed, medical comorbidities,and SSI were recorded and analyzed.ResultsOne hundred and two subjects(64M,38F) met the inclusion criteria. Forty subjects developed a SSI. Analysis of variance revealed that age[P=0.64], gender[P=0.97], use of alcohol[P=0.87], final pathology[P=0.3], cardiovascular disease[P=0.33], diabetes/immune dysfunction[P=0.95] did not have a significant association with the development of a postoperative wound infection. On univariate analysis, non-head and neck primary malignancies demonstrated a significant risk factor for SSI [P=0.03] with previous head and neck surgery [P=0.05] and oral tobacco use [P=0.06] having trends for increased risk of SSI. Clindamycin antibiotic was strongly associated with the development of a SSI with 50% of that cohort developing a recipient SSI [OR 7.0, P<0.002], regardless of the duration of use. The rate of development of a recipient SSI with cefazolin was 25% and for Unasyn it was 19%.ConclusionA statistically significant number of subjects who developed a recipient surgical site infection received clindamycin as perioperative antibiotic prophylaxis. An alternative antibiotic regime other than clindamycin should be considered in patients with an allergy to penicillin/cephalosporin who are undergoing an OFF to the head and neck.



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