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

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Abstract

Objectives

This 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, 2nd 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.

Results

The 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 2nd generation cephalosporins as POABP. 91% of the harvested pathogens (n=193) were susceptible to the combination of 2nd and 3rd generation cephalosporins. Secondly, 92 out 113 (81%) harvested pathogens presented susceptibility to moxifloxacin.

Conclusion

Smaller tissue transfers are less prone to infections of the recipient site and present low LOS. For an POABP regime, the combination of 2nd and 3rd generation cephalosporins presents substantial results in recipient site infections. In cases of allergy, potential pathogens show adequate susceptibility to moxifloxacin.

Clinical relevance

A combination of 2nd and 3rd generation cephalosporins may be used to prevent recipient sites in head and neck surgery.

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Author information

Author notes

  1. Max Zinser and Joachim E. Zöller contributed equally to this work.

Authors and Affiliations

  1. Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany

    Matthias Zirk, Artjom Zalesski, Matthias Kreppel, Max Zinser & Joachim E. Zöller

  2. Department of Dermatology, University of Cologne, Cologne, Germany

    Franziska Peters

  3. Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany

    Franziska Peters

Authors
  1. Matthias Zirk
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  2. Artjom Zalesski
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  4. Matthias Kreppel
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Correspondence to Matthias Zirk.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Local ethnics board exempts this study from a specific ethic vote due to its pure retrospective nature.

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For this type of study (retrospective study), formal consent is not required.

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Zirk, M., Zalesski, A., Peters, F. et al. Oral recipient site infections in reconstructive surgery - impact of the graft itself and the perioperative antibiosis. Clin Oral Invest 24, 1599–1605 (2020). https://doi.org/10.1007/s00784-019-03078-6

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  • DOI: https://doi.org/10.1007/s00784-019-03078-6

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