title: The value of perioperative antibiotics on the success of oral free flap reconstructions.
abstract: The subject of the presented study was to monitor and compare problems and outcomes of reconstructive surgery with microvascular free flaps in the head and neck region between groups of patients treated with perioperative antibiotics and a group of patients without antibiotics. Patients requiring oral reconstructive surgery following cancer resections with microvascular free flaps were prospectively evaluated (2007-2012). Antibiotic therapy was started 30 min before the operation and administered for 10 days. Three hundred and fifty patients were included (208 male, 59.4%; 142 female, 40.6%; mean age 59.8 ± 13.2 years). 330 patients received perioperative antibiotics. Twenty patients (5.7%) who received no antibiotics for specific reasons served as the control group. Wound infections developed in 33 of 122 patients (27%) who received benzylpenicillin, 17 of 88 patients (19.3%) who received amoxicillin combined with sulbactam and 25 of 120 patients (20.8%) who received cefuroxime. Ten patients (50%) who did not receive antibiotics developed wound infections. Receiving no antibiotics or penicillin showed no benefit (P = 0.11). Those receiving cefuroxime showed significantly lower incidence of wound infections (P = 0.034; risk decreased by the factor 2.88). The use of amoxicillin combined with sulbactam showed the lowest rate of wound infections (P = 0.018; risk decreased by the factor 3.46). The use of amoxicillin combined with sulbactam appears to be the most appropriate prophylactic antibiotic followed by cefuroxime in oral microsurgical free flap reconstructions. These data may serve as a guide until a controlled multicenter prospective trial is performed comparing newer antibiotics against current standards.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts Der Isar, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mücke
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts Der Isar, Germany.
authors.forename: Nils H
authors.initials: NH
authors.lastname: Rohleder
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts Der Isar, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rau
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts Der Isar, Germany.
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Ritschl
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts Der Isar, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Kesting
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts Der Isar, Germany.
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts Der Isar, Germany.
authors.forename: David A
authors.initials: DA
authors.lastname: Mitchell
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts Der Isar, Germany.
authors.forename: Denys J
authors.initials: DJ
authors.lastname: Loeffelbein
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004334:Drug Administration Schedule; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents