Strategies for Reducing Surgical Site Infections After Oral Cancer Resection and Free-flap Reconstruction

Despite numerous efforts to reduce surgical site infection (SSI) in patients undergoing head and neck reconstruction, infection rates have remained high. Recently, we introduced an original perioperative wound management protocol that includes 3 steps: intraoperative irrigation of the surgical field with iodine saline, compression of the dead space in the postoperative period, and oral care by reconstructive surgeons. Here we described our management protocol and reported changes in SSI rates and associated outcomes.

This study included 120 consecutive patients who underwent resection and free-flap reconstruction for oral cancers at our institution from 2020 to 2022. The study compared cases with perioperative wound management without our protocol (control group, n = 60) and those with our protocol (study group, n = 60). Factors influencing the infection rates were statistically analyzed.

No statistical differences were observed between the 2 groups in patient characteristics. In the univariate logistic regression analysis, perioperative wound management with our protocol (P = 0.012, odds ratio [OR] = 0.350) and age (P = 0.024, OR = 0.963) were significantly associated with infection. In the multivariate analysis, only perioperative wound management with our protocol was significantly correlated with SSI (P = 0.015, OR = 0.353). There was a significant difference in the days nil by mouth (P = 0.014) and the length of hospitalization (P = 0.003) between the groups.

Our perioperative protocol seemed to be effective in preventing postoperative SSIs, reducing the days of nil by mouth, and shortening hospital stay after oral cancer resection and reconstruction.