Wound Infection in Head and Neck Surgery: Implications for Perioperative Antibiotic Treatment

Abstract

Perioperative antibiotic treatment significantly reduces the risk of postoperative wound infection and is cost-effective in clean-contaminated head and neck operations. A clear consensus on the most suitable single agent or combination is, however, lacking. Most surgical wound infections involve both gram-positive and gram-negative aerobes and anaerobes; some organisms may exhibit antibiotic resistance through beta-lactamase production. Comparative trials have indicated that combinations with both aerobic and anaerobic activity provide protection superior to that achieved with single agents active against only aerobic pathogens. Recent results suggest that the beta-lactam/beta-lactamase-inhibitor combination ampi-cillin/sulbactam is cost-effective for perioperative treatment of patients undergoing head and neck surgery.

Neck dissection with simultaneous carotid endarterectomy

“…There exists the potential risk of a carotid blowout due to wound breakdown or infection in these patients 12 . When the pharynx is not opened, we believe that the skin flaps and remaining sternocleidomastoid muscle provide adequate coverage of the repaired carotid artery.…”

Postdischarge Complications Predict Reoperation and Mortality after Otolaryngologic Surgery

“…16 Perioperative antibiotics have been shown to be neither cost-effective nor beneficial in preventing infections in clean uncontaminated otolaryngologic procedures 17,18 but have been shown to be beneficial in clean/contaminated procedures. 19 In a study of postdischarge head and neck wound infections, Reid et al determined that there was no difference in infection rates with the use of antibiotics (7.8% vs 7.9%, P = .99); antibiotics only delayed the occurrence of postdischarge infections (9.8 days vs 11.9 days, P < .001). 14 The current literature regarding prophylactic courses of postoperative antibiotics has been inconclusive since antibiotics may be more likely to be used in cases where physicians believe that they are needed.…”

Antimicrobial Prophylaxis in Adults

“…Mass reproduce only with permission from Mayo Clinic Proceedings a . 112 Same as for hysterectomy Cefazolin h 1-2 g IV Abortion 111 Same as for hysterectomy Doxycycline 300 mg orally o Head and neck 113,114 , oropharyngeal anaerobes, Clindamycin 600-900 mg IV Incision through oral or enteric gram-negative bacilli or Cefazolin 1-2 g IV pharyngeal mucosa…”