Case of late‐onset, relapsing surgical site infection related to a venous coupler placed during free flap reconstruction for major head and neck cancer

Abstract

To the best of our knowledge, this is the first report of a delayed-onset head and neck surgical site infection in which a venous coupler served as a foreign body. An infected foreign body should be suspected in relapsing surgical site infections due to a single organism.

A Case of Streptococcus intermedius Abscess Within a Malignant Neck Mass and Review of the Literature

“…One case, a 79-year-old patient with squamous cell carcinoma of the tongue, had received chemoradiation only days before developing a neck abscess. 6 Unlike our patient, however, this patient's infection was associated with a surgical site and a venous coupler that served as a nidus for recurrent infection with S. intermedius. This patient's initial S. intermedius infection was treated with 5 days of ceftibuten and 1 dose of vancomycin, which were both discontinued because of uncontrollable diarrhea.…”

“…Only 2 cases of S. intermedius infection in postradiation cancer patients were found in the literature. One case, a 79-year-old patient with squamous cell carcinoma of the tongue, had received chemoradiation only days before developing a neck abscess 6 . Unlike our patient, however, this patient's infection was associated with a surgical site and a venous coupler that served as a nidus for recurrent infection with S. intermedius .…”

“…Only 2 articles were specifically patients who had previously received radiation therapy. 6,7 For the articles by Miyamoto et al, 8 Yuba et al, 9 Benou et al, 10 and Ishihara et al, 11 only the abstracts were available so data appearing in the table were extracted from the abstracts. Data related to patient demographics, cancer type, abscess location, treatment, and outcome were collected and summarized in Table 1.…”

“…Five of the articles listed in the table were not in English but were either able to be translated or had abstracts that were available in English. Only 2 articles were specifically patients who had previously received radiation therapy 6,7 . For the articles by Miyamoto et al, 8 Yuba et al, 9 Benou et al, 10 and Ishihara et al, 11 only the abstracts were available so data appearing in the table were extracted from the abstracts.…”

Unique Complications of Venous Anastomotic Couplers: A Systematic Review of the Literature

“…There was one report of a coupler causing late-onset, recurrent surgical site infections likely from bacterial biofilm, which also would not occur in hand-sewn anastomosis. 42 In addition, intraoperative technical issues (e.g., failure of seeding of coupler pins, inability to deploy the anastomotic instrument, tearing of the vessel wall) can occur with couplers and not suture anastomoses. These occasional problems require an additional intraoperative attempt but do not typically affect outcomes and are not reported in the literature.…”