IMPORTANCE Surgical site infections (SSIs) after vascularized reconstruction of the upper aerodigestive tract (UADT) are associated with considerable morbidity. The association between perioperative prophylaxis practices, particularly topical antisepsis, and SSIs remains uncertain.OBJECTIVE To assess the association between perioperative topical antisepsis and SSIs in patients undergoing vascularized reconstruction of the UADT. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included patients from 12 academic tertiary care centers over an 11-month period, from July 1, 2020, to June 1, 2021. Patients undergoing open surgical procedures requiring a communication between the UADT and cervical skin with a planned regional pedicled flap, free flap, or both were included. Patients with an active infection at the time of surgical procedure were excluded. MAIN OUTCOMES AND MEASURESThe primary outcome measure was an SSI within 30 days of surgery. The association of demographic characteristics, perioperative antibiotic prophylaxis, surgical technique, and postoperative care with SSIs was assessed using univariable and multivariable analyses. The relative risk ratio and 95% CIs for developing SSI were calculated for each of the variables based on predetermined categories. Variables for which the relative risk 95% CI did not include the value of zero effect (relative risk = 1.00) were included in the multivariable model.RESULTS A total of 554 patients (median age, 64 years; range, 21-95 years; 367 men [66.2%]) were included. Cancer ablation was the most frequent reason for surgery (n = 480 [86.6%]). Overall, the SSI rate was 20.9% (n = 116), with most infections involving the head and neck surgical site only (91 [78.4%]). The median time to SSI diagnosis was 11 days (range, 1-28 days). Topical antisepsis mucosal preparation was performed preoperatively in 35.2% (195) and postoperatively in 52.2% (289) of cases. Ampicillin and sulbactam was the most common systemic antibiotic prophylaxis agent used (n = 367 [66.2%]), with 24 hours being the most common duration (n = 363 [65.5%]). On multivariable analysis, preoperative topical antisepsis mucosal preparation (odds ratio [OR], 0.49; 95% CI, 0.30-0.77) and systemic prophylaxis with piperacillin and tazobactam (OR, 0.42; 95% CI, 0.21-0.84) were associated with a decreased risk of a postoperative SSI. The use of an osseous vascularized flap was associated with an increased risk of postoperative SSI (OR, 1.76; 95% CI, 1.13-2.75). CONCLUSIONS AND RELEVANCEFindings of this study suggest that preoperative topical antisepsis mucosal preparation was independently associated with a decreased risk of SSIs in a 12-center multi-institutional cohort. Further investigation of the association between individual perioperative practices and the incidence of postoperative SSIs is necessary to develop evidence-based protocols to reduce SSIs after UADT reconstruction.

Background. Mucosa-associated lymphoid tissue (MALT) lymphomas are a subtype of non-Hodgkin lymphoma stemming from marginal zone B-cells. In this case report, we present two patients with an extremely rare localization of MALT lymphoma to the larynx. Methods. Case 1 is of a 78-year-old male presenting with a six-month history of progressive hoarseness with a past medical history significant for marginal zone lymphoma of the right orbit. Diagnosis was confirmed with a biopsy for extranodal marginal zone B-cell lymphoma of MALT type. An FDG-PET scan was done but did not show any sign of FDG avid malignancy, including at the primary site. Case 2 is a 60-year-old female presenting with one year of worsening throat discomfort, intermittent cough, and dyspnea with exertion. Pathology confirmed a diagnosis of extranodal marginal zone B-cell lymphoma of MALT type. Results. Case 1 was treated with low-dose radiation at 4 Gy delivered over two fractions of 2 Gy each. Upon completion of radiation treatment, he reported a resolution of his hoarseness and normalization of his voice. A four-month follow-up in May 2018 with flexible nasolaryngoscopy revealed a normal exam with fully mobile vocal folds bilaterally and no evidence of left false vocal fold submucosal mass. At seven months following treatment, the patient died unexpectedly of unknown causes. Case 2 was treated with radiation at 30 Gy in 15 fractions over the course of one month. Following completion of radiation therapy, she had improvement of her sore throat, nausea, dysphagia, dysgeusia, and dry mouth. At 21-month follow-up, she had no evidence of disease. Conclusion. This case report demonstrates that MALT lymphoma can present with much more benign and subtle symptoms. This highlights the importance of clinicians to keep broad differentials and consider MALT lymphomas in the setting of laryngeal masses.

This is the first report, to our knowledge, of a projectile metal object to the neck that may be related to airbag deployment. The car involved in this accident was under recall for airbags that were associated with projectile objects, which warrants further investigation into the possible risks of such airbags.

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