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A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
The Impact of Postoperative Antibiotics on Outcomes Following Segmental Resection and Microvascular Reconstruction
Marta M Williams1, Francis X Creighton2, Miriam B Barshak3
1Harvard Medical School, Boston, Massachusetts, USA.
Background:
The optimal intravenous (IV) antibiotic regimen following definitive surgical treatment for mandibular osteoradionecrosis (ORN) is unknown. This study evaluated the effect of culture-directed IV antibiotics (based on intraoperative cultures) on early wound complications, including surgical site infections (SSIs) and antibiotic duration on long-term wound healing (healing ≤ 2 months without subsequent complications).
Methods:
Retrospective review of flap reconstruction for ORN (2009-2022, N = 44, 70% free flaps, 30% pedicled).
Results:
Postoperative antibiotics were culture-directed (25 patients) or empiric (19); the SSI rate was lower in the culture-directed group (0% vs. 26.3%, p = 0.01). Twenty-two patients received short-course (mean 9 days) and 22 long-course (mean 43 days) IV antibiotics postoperatively. During follow-up (mean 5.7 years), these groups had similar rates of long-term wound healing (50% vs. 36%, p = 0.54).
Conclusion:
In this series, patients who received culture-directed IV antibiotics postoperatively had zero SSIs. The rate of long-term wound healing was not affected by the antibiotic duration.
Insights
Culture-directed intravenous antibiotics significantly reduced surgical site infections in mandibular osteoradionecrosis (ORN) patients. However, antibiotic duration did not impact long-term wound healing outcomes.
Area of Science:
- Oral and Maxillofacial Surgery
- Surgical Oncology
- Infectious Diseases
Background:
- Optimal intravenous antibiotic regimens for mandibular osteoradionecrosis (ORN) post-surgery remain undefined.
- This study investigates the impact of culture-directed versus empiric IV antibiotics on early and long-term wound healing.
- Early wound complications, including surgical site infections (SSIs), and long-term healing were assessed.
Purpose of the Study:
- To evaluate the effectiveness of culture-directed IV antibiotics in reducing early wound complications after ORN surgery.
- To determine if the duration of postoperative IV antibiotic therapy influences long-term wound healing in ORN patients.
Main Methods:
- Retrospective review of 44 patients undergoing flap reconstruction for ORN between 2009 and 2022.
- Analysis of postoperative antibiotic strategies: culture-directed (n=25) versus empiric (n=19).
- Comparison of short-course (mean 9 days) versus long-course (mean 43 days) IV antibiotic durations.
Main Results:
- The culture-directed antibiotic group demonstrated a significantly lower SSI rate (0%) compared to the empiric group (26.3%, p=0.01).
- No significant difference in long-term wound healing rates (50% vs. 36%, p=0.54) was observed between short-course and long-course antibiotic groups.
- Mean follow-up duration was 5.7 years.
Conclusions:
- Culture-directed IV antibiotics are associated with zero SSIs in ORN surgical patients.
- The duration of postoperative IV antibiotic therapy does not appear to affect the rate of long-term wound healing in ORN.
- Intraoperative cultures guide effective antibiotic selection for preventing early complications.
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