Patients who undergo major contaminated surgery of the head and neck benefit from perioperative antibiotic prophylaxis. This study was developed to determine if 5 days of antibiotic administration would be more effective than 1 day. A multi-institutional prospective randomized double-blind study was designed. Patients who were identified as requiring pedicled flap reconstruction were potential candidates for the study. Later, patients were randomly assigned to receive cefoperazone sodium for either 24 hours or 120 hours. In each case, the drug was administered intravenously, beginning 1 to 2 hours preoperatively and continued for the prescribed period. One hundred nine patients were evaluable. Fifty-three patients were assigned to 1 day of perioperative prophylaxis. Wound infection developed in ten patients (18.9%). Fifty-six patients were assigned to 5 days of perioperative antibiotic prophylaxis. Wound infection developed in 14 (25%) of these patients (P greater than .05). These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours postoperatively can be achieved in patients who undergo myocutaneous flap reconstruction.

Tracheoesophageal puncture is not a complex procedure; nevertheless, significant complications are possible. In the last four years we have performed this procedure in 47 patients. Seven of them (15%) sustained significant complications related to the procedure. These included three cases of mediastinitis and sepsis, although surgical drainage was not required. Three other patients developed cellulitis of the trachea and root of the neck, centered around the tract through the party wall; one patient suffered a fracture of the cervical spine. Eight lesser complications also occurred. Tracheoesophageal puncture's simplicity and effectiveness surpass those of any other surgical procedure for voice restoration. However, our experience demonstrates that, as with any operation, the technique may be associated with significant operative complications.

No abstract