title: Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure.
abstract: BACKGROUND
  Plate-related complications following head and neck cancer ablation and reconstruction remains a challenging problem often requiring further management and reconstructive surgeries. We aim to identify an association between surgical site infections (SSI) and plate exposure.
  
  
  METHODS
  A retrospective study between 1997 and 2014 was performed to study the association between postoperative SSI and plate exposures. Eligible patients included those with a history of oral squamous cell carcinoma who underwent surgical resection, neck dissection, and free tissue reconstruction. Demographic and treatment related information was collected. SSI were classified based on CDC definition and previously published literature. Univariable analysis on demographic factors, smoking history, diabetes, radiation, surgical and hardware related factors; while multivariable analysis on SSI, plate height, segmental mandibulectomy defects and radiation were conducted such as using cox proportional hazard models.
  
  
  RESULTS
  Three hundred sixty-five patients were identified and included in our study. The mean age of the study group was 59.2 (+/-13.8), with a predominance of male patients (61.9%). 10.7% of our patient cohort had diabetes, and another 63.8% had post-operative radiation therapy. Patients with SSI were more likely to have plate exposure (25 vs. 6.4%, p <0.001). Post-operative SSI, mandibulectomy defects, and plate profile/thickness were associated with plate exposure on univariable analysis (OR = 5.72, p < 0.001; OR = 2.56, p = 0.014; OR = 1.44, p = 0.003 respectively) and multivariable analysis (OR = 5.13, p < 0.001; OR = 1.36, p = 0.017; OR = 2.58, p = 0.02 respectively).
  
  
  CONCLUSIONS
  Surgical site infections are associated with higher rates of plate exposure. Plate exposure may require multiple procedures to manage and occasionally free flap reconstruction.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Yao
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada.
authors.forename: Hedyeh
authors.initials: H
authors.lastname: Ziai
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Tsang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Copeland
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada.
authors.forename: Dale
authors.initials: D
authors.lastname: Brown
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Gilbert
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada.
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gullane
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada. john.dealmeida@uhn.ca.
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D063168:Mandibular Osteotomy / Q000009:adverse effects*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology*; D055815:Young Adult
keywords: Head and neck cancer; Mandibular reconstruction; Plate exposure; Plate height; Plate-related Complications; Surgical Site Infections