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Published on: January 28, 2020
A prospective study on infectious complications in orthognathic surgery
Yannick J E Spaey1, Rolf M A Bettens, Maurice Y Mommaerts
1Department of Surgery, Division of Maxillo-Facial Surgery, General Hospital, St. Jan, Brugge, Belgium.
Aim:
According to an earlier study in 2000, 4.7% of patients undergoing corrective facial orthopaedic surgery in this unit suffered a postoperative wound infection. In 1998, the Belgian Government recommended stricter rules for infection prophylaxis and a new antibiotic protocol similar to that proposed by Peterson (1990) was implemented in this unit. The new protocol was to be evaluated.
Material And Methods:
Eight hundred and ten consecutive patients were selected receiving orthognathic surgery (Le Fort I-type osteotomies, sagittal split osteotomies, segmental and chin osteotomies). Cefazolin 1g was administered intravenously on induction of general anaesthesia and repeated at 4h intervals for the duration of surgery. No antibiotics were administered postoperatively. The observation period was 6 weeks. When an infection occurred, appropriate culture specimens were obtained according to a standardized protocol.
Results:
Fifty-one infections (6.8%) were diagnosed, 33 with purulent exudates occurring spontaneously or after incision and drainage. Ninety-two per cent of these infections occurred in the sagittal split area, 6% in the maxillary region and 2% in the chin region. Infections in the sagittal split area were further analysed. A reduction in infection rate from 6.6 to 2.6% was noted following a change in practice when fibrin glue was used in the wound instead of a drain in the sagittal split wound. Of the 30 aerobic cultures, 12 contained normal mucosal flora, of which 9 were Streptococcus species. In 11 of the 30 anaerobic cultures the identified species belonged to the Bacteroides group. This bacterium is resistant to cefazolin but sensitive to amoxicillin-clavulanate and for a high percentage also to clindamycin. All the other cultures were sterile.
Conclusion:
The infections occurring almost exclusively in the sagittal split osteotomy site can be partially explained by wound contamination upon removal of the drain. It is suggested that for prophylaxis cefazolin is replaced by amoxicillin-clavulanate.
Insights
Postoperative wound infections after facial orthognathic surgery occurred at 6.8%. Infections were concentrated in the sagittal split area, suggesting drain contamination. Amoxicillin-clavulanate is recommended over cefazolin for prophylaxis.
Area of Science:
- Oral and Maxillofacial Surgery
- Infectious Disease Epidemiology
Background:
- A previous study in 2000 reported a 4.7% postoperative wound infection rate in facial orthognathic surgery.
- Stricter infection prophylaxis rules and a new antibiotic protocol were implemented in 1998.
- The efficacy of the new protocol required evaluation.
Purpose of the Study:
- To evaluate the postoperative wound infection rate following the implementation of a new antibiotic protocol for facial orthognathic surgery.
- To identify the common sites and potential causes of infections.
- To assess the effectiveness of the current antibiotic prophylaxis.
Main Methods:
- A cohort of 810 consecutive patients undergoing orthognathic surgery (Le Fort I, sagittal split, segmental, and chin osteotomies) was studied.
- Cefazolin 1g was administered intravenously at induction and every 4 hours during surgery; no postoperative antibiotics were given.
- Patients were observed for 6 weeks, with standardized protocols for infection diagnosis and specimen collection.
Main Results:
- A total of 51 infections (6.8%) were diagnosed, predominantly in the sagittal split osteotomy site (92%).
- A significant reduction in infection rate from 6.6% to 2.6% was observed after switching from wound drains to fibrin glue in sagittal split procedures.
- Bacteroides species, resistant to cefazolin, were identified in anaerobic cultures from infected sites.
Conclusions:
- Wound contamination during drain removal likely contributes to infections at the sagittal split osteotomy site.
- The current cefazolin prophylaxis may be inadequate due to resistance in common pathogens.
- Amoxicillin-clavulanate is suggested as a more effective prophylactic antibiotic agent for these procedures.
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