Oral recipient site infections in reconstructive surgery - impact of the graft itself and the perioperative antibiosis

ObjectivesThis study was designed to assess the influence of peri/post-operative antibiotic prophylaxis (POABP) and the reconstructive graft itself on recipient sites infections in head and neck surgery.Materials and Methods:In this retrospective cohort study, 322 consecutive patients with reconstructive surgery were investigated. The primary objective was to analyze the differences of commonly applied reconstructive grafts on the occurrence of oral recipient site infections. Moreover, differences of POABP regimes (namely: ampicillin/sulbactam, 2(nd) generation cephalosporins, clindamycin) and antibiotic alternatives were investigated. In addition, patients' length of in-hospital stay was analyzed in regard to reconstructive graft and POABP regime.ResultsThe free radial forearm flap and split-thickness skin graft presented significantly less recipient site infections and shorter length of in-hospital stays (LOS) in comparison to further six reconstructive technique with pedicled tissue transfer or bone transfers. LOS was significantly shorter for patients with ampicillin/sulbactam than with 2(nd) generation cephalosporins as POABP. 91% of the harvested pathogens (n=193) were susceptible to the combination of 2(nd) and 3(rd) generation cephalosporins. Secondly, 92 out 113 (81%) harvested pathogens presented susceptibility to moxifloxacin.ConclusionSmaller tissue transfers are less prone to infections of the recipient site and present low LOS. For an POABP regime, the combination of 2(nd) and 3(rd) generation cephalosporins presents substantial results in recipient site infections. In cases of allergy, potential pathogens show adequate susceptibility to moxifloxacin.Clinical relevanceA combination of 2(nd) and 3(rd) generation cephalosporins may be used to prevent recipient sites in head and neck surgery.