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Postoperative wound infections following myocutaneous flap surgery in spinal injury patients
M Garg1, S Rubayi, J Z Montgomerie
1Department of Medicine, Rancho Los Amigos Medical Center, Downey, California 90242.
Abstract:
Severe pressure ulcers in patients with spinal cord injury are frequently treated by using musculocutaneous (m-c) flap surgery. There have been few studies of the use of perioperative antibiotics to prevent postoperative infection in this setting. We reviewed 74 m-c flap surgeries in 53 patients (41 male and 12 female) from October 1989 for one year. The sites involved were ischial (31), sacral (24), trochanteric (18), deltoid (2), olecranon (1) and posterior thigh (1). An antibiotic was usually administered perioperatively for 5 days. Patients were followed for a median of 30 (8-96) weeks. Postoperative infections occurred at a median of 12 (4-25) days in 6 of 74 (8%) surgeries. The organisms cultured from the 6 infected wounds were: Bacteroides sp. (4), Proteus mirabilis (2), E. coli (2), MRSA (2), and others (6--each isolated once). These results indicate that antibiotics did not prevent postoperative infection in approximately 8% of patients undergoing m-c surgery. The frequency of isolation of Bacteroides sp. from these infections suggests that anaerobic bacteria may persist in healing pressure ulcers and perioperative antibiotics might include coverage for anaerobic bacteria.
Insights
Perioperative antibiotics did not fully prevent infections in musculocutaneous flap surgeries for spinal cord injury patients. Anaerobic bacteria, like Bacteroides, were common in infections, suggesting a need for broader antibiotic coverage.
Area of Science:
- Surgical Oncology
- Infectious Diseases
- Reconstructive Surgery
Background:
- Musculocutaneous (m-c) flap surgery is common for severe pressure ulcers in spinal cord injury patients.
- Postoperative infection is a significant complication.
- Limited research exists on perioperative antibiotic efficacy in this specific surgical context.
Purpose of the Study:
- To evaluate the effectiveness of perioperative antibiotics in preventing postoperative infections following m-c flap surgery for pressure ulcers.
- To identify common pathogens in postoperative infections to guide antibiotic strategies.
Main Methods:
- Retrospective review of 74 m-c flap surgeries in 53 spinal cord injury patients over one year.
- Analysis of surgical sites, patient demographics, antibiotic administration (typically 5 days perioperatively), and follow-up duration (median 30 weeks).
- Identification of microorganisms cultured from infected wounds.
Main Results:
- Postoperative infections occurred in 6 of 74 (8%) surgeries, with a median onset of 12 days.
- Commonly isolated organisms included Bacteroides sp. (4), Proteus mirabilis (2), E. coli (2), and MRSA (2).
- Perioperative antibiotics did not prevent infection in all cases.
Conclusions:
- Standard perioperative antibiotic regimens were associated with an 8% infection rate in m-c flap surgeries for spinal cord injury.
- The high prevalence of Bacteroides sp. suggests anaerobic bacteria are significant pathogens.
- Future antibiotic strategies should consider coverage for anaerobic bacteria in these patients.