Image-guided puncture drainage as a first-line management for postoperative abscess following head and neck...

Postoperative abscess formation remains a clinically significant complication following head and neck reconstruction. It may prolong hospitalization, delay rehabilitation, and complicate postoperative recovery. With advancements in interventional imaging, image-guided puncture drainage (IGD) has emerged as a minimally invasive management option; however, its appropriate indications remain unclear. This study aimed to characterize postoperative abscesses and evaluate the clinical effectiveness of IGD as a first-line management strategy in selected patients undergoing head and neck reconstruction.

This retrospective case series included patients who developed an abscess within 30 days after flap reconstruction for head and neck malignancies at The Jikei University School of Medicine between January 2022 and December 2024. Diagnosis was confirmed by clinical findings and ultrasonography or computed tomography (CT). Patients with hematoma or lymphatic leakage without infection were excluded. Primary outcomes were drainage modality and duration of wound care until complete healing. Secondary outcomes included microbiological findings, antibiotic use, and abscess recurrence. Abscesses were categorized as early-onset (≤ 7 days) or late-onset (≥10 days). IGD was performed under ultrasound or CT guidance; open drainage was reserved for diffuse infection or suspected flap perfusion disorder.

Fourteen patients (12 male, median age 75 years [range 24-84]) were included in the study. IGD was performed in 9 patients (64%) and achieved complete resolution in 7 (78%), while 2 required secondary conversion to open drainage due to persistent infection. The remaining 5 patients underwent primary open drainage. The median duration of wound care was 1 day (range, 1-42) in the initial IGD group and 34 days (range, 14-42) in the initial open drainage group. Culture results demonstrated mixed oral aerobic and anaerobic bacteria, most commonly Staphylococcus aureus and Streptococcus anginosus group. Only three prophylactic drain-tip cultures were positive, and none matched the organisms isolated from abscesses. No flap loss, major bleeding, or recurrence of abscess occurred during the 3-month follow-up period.

IGD represents a safe, effective, and minimally invasive first-line management option for postoperative abscesses following head and neck reconstruction when flap perfusion is preserved and the abscess is well-localized. Open drainage should be reserved for early-onset abscesses or those with flap perfusion disorder. An imaging-based treatment algorithm can help optimize management and support earlier postoperative recovery.