Takaya Makiguchi1, Satoshi Yokoo2, Yuki Kanno3, Jun Kurihara3, Keisuke Suzuki4. 1. Associate Professor, Department of Oral and Maxillofacial Surgery and Plastic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan. Electronic address: takayamakiguchi@gmail.com. 2. Professor, Department of Oral and Maxillofacial Surgery and Plastic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan. 3. Assistant Professor, Department of Oral and Maxillofacial Surgery and Plastic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan. 4. Resident, Department of Oral and Maxillofacial Surgery and Plastic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
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: Eighty-eight patients who underwent this procedure composed a nonrandomized retrospective cohort. RESULTS: Recipient site SSIs occurred in 27 patients (30.7%). In multivariate analysis, flap necrosis (partial or total; P = .003; odds ratio [OR] = 12.8) and preoperative hypoalbuminemia (P = .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 = .026; OR = 25.0) and preoperative hypoalbuminemia (P = .014; OR = 11.0) were significant risk factors for recipient site SSI. CONCLUSIONS: These results suggest that different preoperative nutritional interventions, such as a diet enriched with energy and protein, oral nutritional supplements, and, in patients with compromised swallow, enteral tube feeding or parenteral nutrition, could be important to decrease the frequency of recipient site SSIs. Pedicled and free flaps might result in SSIs for different reasons. Partial necrosis occurred more often with pedicled flaps than with free flaps and it might be important to use different techniques to decrease skin flap necrosis to lower the rate of SSIs.
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: Eighty-eight patients who underwent this procedure composed a nonrandomized retrospective cohort. RESULTS: Recipient site SSIs occurred in 27 patients (30.7%). In multivariate analysis, flap necrosis (partial or total; P = .003; odds ratio [OR] = 12.8) and preoperative hypoalbuminemia (P = .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 = .026; OR = 25.0) and preoperative hypoalbuminemia (P = .014; OR = 11.0) were significant risk factors for recipient site SSI. CONCLUSIONS: These results suggest that different preoperative nutritional interventions, such as a diet enriched with energy and protein, oral nutritional supplements, and, in patients with compromised swallow, enteral tube feeding or parenteral nutrition, could be important to decrease the frequency of recipient site SSIs. Pedicled and free flaps might result in SSIs for different reasons. Partial necrosis occurred more often with pedicled flaps than with free flaps and it might be important to use different techniques to decrease skin flap necrosis to lower the rate of SSIs.