Risk factors for surgical site infection in patients undergoing free and pedicled myocutaneous flap reconstruction after oral cancer resection

Publication date: Available online 4 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Takaya Makiguchi, Satoshi Yokoo, Yuki Kanno, Jun Kurihara, Keisuke Suzuki

Abstract

Purpose

The aim of the study was to investigate risk factors for surgical site infection (SSI) at the recipient site in oral cancer resection surgery with neck dissection and reconstruction using a free or pedicled myocutaneous flap.

Patients and Methods

The subjects were a nonrandomized, retrospective cohort of 88 patients who underwent this procedure.

Results

Recipient site SSIs occurred in 27 patients (30.7%). In multivariate analysis, flap necrosis (partial or total) (P=0.003, odds ratio [OR]=12.8) and preoperative hypoalbuminemia (P=0.025, OR=3.9) were independent risk factors for recipient site SSI. In an analysis restricted to flap survival cases, free flap (vs. pedicled flap) (P =0.026, OR =25.0) and preoperative hypoalbuminemia (P =0.014, OR =11.0) were significant risk factors for recipient site SSI.

Conclusion

These results suggest that a variety of preoperative nutritional interventions, such as an enriched diet in energy and protein, oral nutritional supplements and, in the patients with compromised swallow, enteral tube feeding or parenteral nutrition, may be important to reduce the frequency of recipient site SSI. Pedicled and free flaps might result in SSI for different reasons. With pedicled flaps, partial necrosis occurred more than with free flaps and it might be important to use a variety of techniques to reduce the skin flap necrosis to reduce the rate of SSI.

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