Abstract. Osteocutaneous flap (OCF) mandible reconstruction is at
high risk for surgical site infection. This study aimed to describe
diagnosis, management, and outcome of OCF-related osteomyelitis. All
patients managed at our institution for an OCF-related osteomyelitis
following mandible reconstruction were included in a retrospective cohort
study (2012–2019). Microbiology was described according to gold-standard
surgical samples, considering all virulent pathogens, and potential
contaminants if present on at least two samples. Determinants of treatment
failure were assessed by logistic regression and Kaplan–Meier curve
analysis. The 48 included patients (median age 60.5 (IQR, 52.4–66.6) years)
benefited from OCF mandible reconstruction mostly for carcinoma (n=27/48;
56.3 %) or osteoradionecrosis (n=12/48; 25.0 %). OCF-related
osteomyelitis was mostly early (≤3 months post-surgery; n=43/48;
89.6 %), presenting with local inflammation (n=28/47; 59.6 %), nonunion (wound dehiscence)
or sinus tract (n=28/47; 59.6 %), and/or bone or device exposure
(n=21/47; 44.7 %). Main implicated pathogens were Enterobacteriaceae (n=25/41; 61.0 %),
streptococci (n=22/41; 53.7 %), Staphylococcus aureus (n=10/41; 24.4 %), enterococci
(n=9/41; 22.0 %), non-fermenting Gram-negative bacilli (n=8/41;
19.5 %), and anaerobes (n=8/41; 19.5 %). Thirty-nine patients (81.3 %)
benefited from surgery, consisting of debridement with implant retention
(DAIR) in 25/39 (64.1 %) cases, associated with 93 (IQR, 64–128) days of
antimicrobial therapy. After a follow-up of 18 (IQR, 11–31) months, 24/48
(50.0 %) treatment failures were observed. Determinants of treatment
outcomes were DAIR (OR, 3.333; 95 % CI, 1.020–10.898) and an early
infectious disease specialist referral (OR, 0.236 if ≤2 weeks;
95 % CI, 0.062–0.933). OCF-related osteomyelitis following mandibular reconstruction represents
difficult-to-treat infections. Our results advocate for a multidisciplinary
management, including an early infectious-disease-specialist referral to
manage the antimicrobial therapy driven by complex microbiological
documentation.