Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure

Abstract

BackgroundPlate-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.MethodsA 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.ResultsThree 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).ConclusionSurgical site infections are associated with higher rates of plate exposure. Plate exposure may require multiple procedures to manage and occasionally free flap reconstruction.

Titanium Reconstruction Plate Exposure Following Mandibular Reconstruction in Malignancy – A Case Report and Review of Literature

“…Infections of the head and neck following ablative surgery may lead to bacterial colonization of plates, resulting in biofilm formation, wound contamination, and subsequent plate exposure requiring hardware removal to eliminate the nidus of infection. [9] Persistent infection was not controlled by all types of higher antibiotics in this case.…”

“…This is likely due to the length of the plate in addition to the associated soft-tissue defects. [9] In the present case, mandibulectomy was performed.…”

“…Whichever reconstruction method is chosen, if insufficient bone and soft tissue were used to reconstruct the defect, wound contracture and steady pressure of the plate against the skin may lead to eventual plate exposure. [9] In one study, over-reconstructing medial softtissue aspects and obliterating dead space resulted in a reduction of plate exposures from 38% to 8% even in patients reconstructed with lateral defects with a plate and soft tissue. [12] Anchoring the Plate to the Surrounding Tissue…”

Oral cavity cancers: A single-center study

“…According to the literature, surgical site infections (SSIs) following head and neck cancer surgery may occur in up to 10 to 45% of cases, despite antibiotic prophylaxis. [28] Yao et al [29] reported that 84 patients (23%) of 365 patients developed SSI within 30 days of the operation and the most common SSI formed were neck abscesses (11.5%). In the present study, we observed SSI in 31 patients (6.8%), which is much lower than similar studies.…”

Otorhinolaryngological profile and surgical intervention in patients with HIV/AIDS

“…HIV disease status was classified using world health organization (WHO) clinical stage classification 24 . SSI were defined as infections occurring within 30 days of the procedure, according to the CDC parameters 26 , 27 . TB screen in HIV/AIDS patients were conducted using the WHO-recommended symptom screen (cough, fever, night sweats, weight loss) 28 .…”