title: Surgical Site Infections in Major Head and Neck Surgeries Involving Pedicled Flap Reconstruction.
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.
authors.affiliation: Harvard Medical School, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA ngoyal1@hmc.psu.edu.|Department of Surgery, Division of Otolaryngology Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Neerav
authors.initials: N
authors.lastname: Goyal
authors.affiliation: Harvard Medical School, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.|Lahey Hospital & Medical Center, Department of Otolaryngology, Burlington, Massachusetts, USA.
authors.forename: Bharat B
authors.initials: BB
authors.lastname: Yarlagadda
authors.affiliation: Harvard Medical School, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Deschler
authors.affiliation: Harvard Medical School, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Emerick
authors.affiliation: Harvard Medical School, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.
authors.forename: Derrick T
authors.initials: DT
authors.lastname: Lin
authors.affiliation: Department of Nursing, Massachusetts Eye and Ear, Boston, Massachusetts, USA.
authors.forename: Debbie L
authors.initials: DL
authors.lastname: Rich
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Rocco
authors.affiliation: Massachusetts General Hospital, Department of Medicine, Infectious Disease Unit, and Massachusetts Eye and Ear, Infectious Disease Service, Boston, Massachusetts, USA.
authors.forename: Marlene L
authors.initials: ML
authors.lastname: Durand
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D002981:Clindamycin / Q000008:administration & dosage; D017577:Cutaneous Fistula / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008404:Massachusetts / Q000453:epidemiology; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D061646:Operative Time; D013517:Otorhinolaryngologic Surgical Procedures; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology; D013524:Surgical Flaps / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin
keywords: fistula; head and neck cancer; pedicled flaps; reconstructive surgery; surgical site infections