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Porcine As a Training Module for Head and Neck Microvascular Reconstruction
Published on: September 29, 2018
Postoperative infections associated with microvascular free flaps in head and neck reconstruction: Analysis of risk
Y Gugliotta1, S Rubattino1, M Fasolis1
1Department of Surgical Sciences, Maxillo-Facial Surgery Unit, AOU Città della Salute e della Scienza, University of Turin, Italy.
Abstract:
Currently, large defects of the head and neck regions are mainly reconstructed using microvascular free flap. Postoperative infections, including surgical site infections (SSIs) and medical postoperative infections (MPI), are important causes of morbidity and worsening of surgical outcomes. The authors aimed to analyze the results obtained using a standardized prophylaxis protocol in a series of 100 consecutive patients who underwent microvascular reconstruction surgery between 2016 and 2021 at a single institution, to identify the risk factors, which could be overcome, to minimize the incidence of infectious complications. In this study, 24 patients developed infectious complications. Higher American Society of Anesthesiologists (ASA) score was statistically associated with higher risk of infectious complications (p = 0.01), need for postoperative transfusions (p = 0.01), and higher T and N stage (p = 0.03 and p = 0.02, respectively) in patients with cancer. We also found a correlation between the increase in surgery duration, hospitalization, and intensive care unit (ICU) stay with higher risk of infection (p = 0.03, p = 0.01, and p = 0.001, respectively). Nine patients reported partial or total flap necrosis and in this group of patients, a higher incidence of infectious complication was recorded (p = 0.001). Our experience shows that SSIs and MPIs affect the global and surgical outcomes of patients and both their incidences can be reduced by correcting potential risk factors preoperatively (e.g., anemia), intraoperatively (amount of blood loss and duration of surgery), and postoperatively (duration of hospitalization and ICU stay and early elimination of potential sources of infection).
Insights
Postoperative infections after head and neck reconstruction surgery increase morbidity. A standardized prophylaxis protocol and managing risk factors like American Society of Anesthesiologists score can reduce infection rates.
Area of Science:
- Plastic Surgery
- Surgical Oncology
- Infectious Disease Prevention
Background:
- Microvascular free flap reconstruction is standard for large head and neck defects.
- Postoperative infections, including surgical site infections (SSIs) and medical postoperative infections (MPI), significantly impact patient morbidity and surgical outcomes.
- Minimizing infectious complications is crucial for improving patient recovery and overall results.
Purpose of the Study:
- To analyze infectious complications in patients undergoing microvascular reconstruction.
- To identify modifiable risk factors associated with these infections.
- To evaluate the effectiveness of a standardized prophylaxis protocol in reducing infection incidence.
Main Methods:
- A retrospective analysis of 100 consecutive patients undergoing microvascular reconstruction between 2016 and 2021.
- Data collection included patient demographics, American Society of Anesthesiologists (ASA) scores, cancer staging (T and N), surgery duration, blood loss, and postoperative outcomes.
- Statistical analysis was performed to identify risk factors associated with infectious complications.
Main Results:
- Twenty-four patients (24%) developed infectious complications.
- Higher ASA scores, increased surgery duration, longer hospitalization, and intensive care unit (ICU) stay were significantly associated with higher infection risk.
- Patients with higher T and N stage cancer also showed a higher risk of infection. Flap necrosis was strongly linked to infectious complications.
Conclusions:
- Infectious complications significantly affect both global and surgical outcomes in head and neck reconstruction patients.
- Proactive management of risk factors, including preoperative correction of anemia, intraoperative control of blood loss and surgery duration, and postoperative optimization of hospitalization and ICU stay, can reduce SSI and MPI incidence.
- A standardized prophylaxis protocol, coupled with vigilant risk factor management, is essential for improving patient safety and surgical success.
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