Salivary scan after major ablative head and neck surgery with prediction of postoperative fistulization

Patients with carcinoma of the head and neck undergoing major ablative and reconstructive procedures following periods of prolonged debilitation, chemotherapy, and/or radiation therapy have been identified as having a high risk for postoperative wound complication, most often infection. Does postoperative wound infection arise de novo, does infection result from failure of prophylactic antibiotic coverage, or is it the result of anastomatic salivary leak? To investigate the incidence of unrecognized salivary leak into the neck, 24 patients underwent salivary radioisotope studies using technetium 99m sodium pertechnetate from three to six days postoperatively. The isotope was administered early in the morning with drainage bags empty. Patients and the collection system were scanned for activity between four and six hours later. Nine patients had postoperative evidence of salivary secretion radioactivity in their drainage system. All of these patients developed transient wound infections or fistulas. The remaining 15 had no uptake in their collection systems and no wound complications. We suggest that the preliminary results from this noninvasive, simply administered study indicate that the infected surgical neck wound may be secondary to unrecognized postoperative salivary contamination. This technique can be used to provide early identification of potential wound infection. Alternatively, information generated by this kind of study may be valuable in predicting patients with the highest risk for postoperative infection, thereby offering guidelines for the use of perioperative antibiotic prophylaxis.