Surgical Site Infections in Major Head and Neck Surgeries Involving Pedicled Flap Reconstruction

Neerav Goyal, Bharat B. Yarlagadda, Daniel G. Deschler, Kevin S. Emerick, Derrick T. Lin, Debbie L. Rich, James W. Rocco, Marlene L. Durand

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: To evaluate surgical site infections (SSI) after pedicled reconstruction in head and neck surgery. Methods: Records of patients with pedicled flap reconstructions between 2009 and 2014 at Massachusetts Eye and Ear were reviewed. Onset of SSI or fistula ≤30 days postoperatively was noted. A free flap cohort was reviewed for comparison. Results: Two hundred and eight pedicled reconstructions were performed for cancer (83%), osteoradionecrosis (7%), and other reasons (10%). Most (72%) cases were clean-contaminated and American Society of Anesthesiologists classification 3 or higher (73%); 63% of patients had prior radiation. The SSIs occurred in 9.1% and were associated with a longer length of stay (P =.004) but no particular risk factors. Seventeen patients developed a fistula (11 without SSI). The SSI rates were not significantly different between pedicled and free flaps, but pedicled flap patients were older, more likely to have had prior surgery and/or radiation, and be methicillin-resistant Staphylococcus aureus positive. In the combined population, multivariate analysis demonstrated clean-contaminated wound classification (P =.03), longer operating time (P =.03), and clindamycin prophylaxis (P =.009) as SSI risk factors. Conclusions: The SSI rate following pedicled flap surgeries was low and similar to free flap surgeries despite a significantly different population. No specific risk factors were associated with developing a pedicled flap SSI.

Original languageEnglish (US)
Pages (from-to)20-28
Number of pages9
JournalAnnals of Otology, Rhinology and Laryngology
Volume126
Issue number1
DOIs
StatePublished - Jan 1 2017

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Surgical Wound Infection
Surgical Flaps
Neck
Head
Free Tissue Flaps
Fistula
Osteoradionecrosis
Radiation
Clindamycin
Methicillin-Resistant Staphylococcus aureus
Population
Ear
Length of Stay
Multivariate Analysis
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Otorhinolaryngology

Cite this

Goyal, Neerav ; Yarlagadda, Bharat B. ; Deschler, Daniel G. ; Emerick, Kevin S. ; Lin, Derrick T. ; Rich, Debbie L. ; Rocco, James W. ; Durand, Marlene L. / Surgical Site Infections in Major Head and Neck Surgeries Involving Pedicled Flap Reconstruction. In: Annals of Otology, Rhinology and Laryngology. 2017 ; Vol. 126, No. 1. pp. 20-28.
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abstract = "Objective: To evaluate surgical site infections (SSI) after pedicled reconstruction in head and neck surgery. Methods: Records of patients with pedicled flap reconstructions between 2009 and 2014 at Massachusetts Eye and Ear were reviewed. Onset of SSI or fistula ≤30 days postoperatively was noted. A free flap cohort was reviewed for comparison. Results: Two hundred and eight pedicled reconstructions were performed for cancer (83{\%}), osteoradionecrosis (7{\%}), and other reasons (10{\%}). Most (72{\%}) cases were clean-contaminated and American Society of Anesthesiologists classification 3 or higher (73{\%}); 63{\%} of patients had prior radiation. The SSIs occurred in 9.1{\%} and were associated with a longer length of stay (P =.004) but no particular risk factors. Seventeen patients developed a fistula (11 without SSI). The SSI rates were not significantly different between pedicled and free flaps, but pedicled flap patients were older, more likely to have had prior surgery and/or radiation, and be methicillin-resistant Staphylococcus aureus positive. In the combined population, multivariate analysis demonstrated clean-contaminated wound classification (P =.03), longer operating time (P =.03), and clindamycin prophylaxis (P =.009) as SSI risk factors. Conclusions: The SSI rate following pedicled flap surgeries was low and similar to free flap surgeries despite a significantly different population. No specific risk factors were associated with developing a pedicled flap SSI.",
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Goyal, N, Yarlagadda, BB, Deschler, DG, Emerick, KS, Lin, DT, Rich, DL, Rocco, JW & Durand, ML 2017, 'Surgical Site Infections in Major Head and Neck Surgeries Involving Pedicled Flap Reconstruction', Annals of Otology, Rhinology and Laryngology, vol. 126, no. 1, pp. 20-28. https://doi.org/10.1177/0003489416672871

Surgical Site Infections in Major Head and Neck Surgeries Involving Pedicled Flap Reconstruction. / Goyal, Neerav; Yarlagadda, Bharat B.; Deschler, Daniel G.; Emerick, Kevin S.; Lin, Derrick T.; Rich, Debbie L.; Rocco, James W.; Durand, Marlene L.

In: Annals of Otology, Rhinology and Laryngology, Vol. 126, No. 1, 01.01.2017, p. 20-28.

Research output: Contribution to journalArticle

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T1 - Surgical Site Infections in Major Head and Neck Surgeries Involving Pedicled Flap Reconstruction

AU - Goyal, Neerav

AU - Yarlagadda, Bharat B.

AU - Deschler, Daniel G.

AU - Emerick, Kevin S.

AU - Lin, Derrick T.

AU - Rich, Debbie L.

AU - Rocco, James W.

AU - Durand, Marlene L.

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N2 - Objective: To evaluate surgical site infections (SSI) after pedicled reconstruction in head and neck surgery. Methods: Records of patients with pedicled flap reconstructions between 2009 and 2014 at Massachusetts Eye and Ear were reviewed. Onset of SSI or fistula ≤30 days postoperatively was noted. A free flap cohort was reviewed for comparison. Results: Two hundred and eight pedicled reconstructions were performed for cancer (83%), osteoradionecrosis (7%), and other reasons (10%). Most (72%) cases were clean-contaminated and American Society of Anesthesiologists classification 3 or higher (73%); 63% of patients had prior radiation. The SSIs occurred in 9.1% and were associated with a longer length of stay (P =.004) but no particular risk factors. Seventeen patients developed a fistula (11 without SSI). The SSI rates were not significantly different between pedicled and free flaps, but pedicled flap patients were older, more likely to have had prior surgery and/or radiation, and be methicillin-resistant Staphylococcus aureus positive. In the combined population, multivariate analysis demonstrated clean-contaminated wound classification (P =.03), longer operating time (P =.03), and clindamycin prophylaxis (P =.009) as SSI risk factors. Conclusions: The SSI rate following pedicled flap surgeries was low and similar to free flap surgeries despite a significantly different population. No specific risk factors were associated with developing a pedicled flap SSI.

AB - Objective: To evaluate surgical site infections (SSI) after pedicled reconstruction in head and neck surgery. Methods: Records of patients with pedicled flap reconstructions between 2009 and 2014 at Massachusetts Eye and Ear were reviewed. Onset of SSI or fistula ≤30 days postoperatively was noted. A free flap cohort was reviewed for comparison. Results: Two hundred and eight pedicled reconstructions were performed for cancer (83%), osteoradionecrosis (7%), and other reasons (10%). Most (72%) cases were clean-contaminated and American Society of Anesthesiologists classification 3 or higher (73%); 63% of patients had prior radiation. The SSIs occurred in 9.1% and were associated with a longer length of stay (P =.004) but no particular risk factors. Seventeen patients developed a fistula (11 without SSI). The SSI rates were not significantly different between pedicled and free flaps, but pedicled flap patients were older, more likely to have had prior surgery and/or radiation, and be methicillin-resistant Staphylococcus aureus positive. In the combined population, multivariate analysis demonstrated clean-contaminated wound classification (P =.03), longer operating time (P =.03), and clindamycin prophylaxis (P =.009) as SSI risk factors. Conclusions: The SSI rate following pedicled flap surgeries was low and similar to free flap surgeries despite a significantly different population. No specific risk factors were associated with developing a pedicled flap SSI.

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