[Wound infection in head and neck cancer surgery]

Wound infections (WIs) are the main cause of post-surgical morbidity in head and neck surgery. They arise with an especially immunocompromised predisposition and mainly involve oropharyngeal flora bacteria. However, the assessment of the incidence of these infections differs in the literature (0 to 87%). This in part accounts for the lack of a real consensus as to the definition (do all mucocutaneous fistulae attest to WIs?). For this reason, the analysis of their risk factors and the means of the prevention is difficult. In class 1 surgery, the incidence of WIs ranges 0 to 6%. In this case, antiobioprophylaxis does not seem to be justified. In surgery opening the mucosa, it is difficult to classify the surgical procedures in Altemeier's classes 2 and 3. There are many arguments, in particular physiopathological arguments, to consider that the contamination of surgical bed of surgery does continue after the operation. The incidence of WIs varies widely from one study to the next. Without antibiotic prophylaxis, from 40 to 87% WIs are observed. With preventive antibiotherapy, the incidence ranges between 3.4 to 47%. Various risk factors have been described, in particular: tumour size and node extension, tracheotomy prior to surgery. Four multi-factor studies have shown, in multivariate analysis, totally different risk factors. The prevention of these WIs is currently based on hospital hygiene rules and antibiotic prophylaxis. The optimum conditions have still not been determined. Reliable data to define, the incidence and risk factors of these WIs are missing. New prospective studies are definitely required.