Antibiotic prophylaxis in major head and neck surgery when clean-contaminated wounds are established

The case reports of 26 consecutive patients undergoing major head and neck surgery establishing direct wound communication between skin and mucosa of the oral cavity or the pharynx were analysed with respect to postoperative wound infections. All but two of the patients were perioperatively administered benzylpenicillin or benzylpenicillin in combination with tinidazole. The frequencies of wound infections were 23-25% when only severe infections as fistulation, pus-formation were taken into account, but 59-75% when also mild infections, not likely to impair the healing, were considered. The most frequently isolated pathogen in the wound infections was beta-lactamase producing Staphylococcus aureus. It is concluded that antibiotic prophylaxis reduces the risk of severe wound infections by approximately 50%. Antimicrobial prophylaxis can only be regarded as an important complement to good surgical techniques.