The subject of the presented study was to monitor and compare problems and outcomes of reconstructive surgery with microvascular
free flaps in the head and neck region between groups of patients treated with perioperative
antibiotics and a group of patients without
antibiotics. Patients requiring oral reconstructive surgery following
cancer resections with microvascular
free flaps were prospectively evaluated (2007-2012).
Antibiotic therapy was started 30 min before the operation and administered for 10 days. Three hundred and fifty patients were included (208 male, 59.4%; 142 female, 40.6%; mean age 59.8 ± 13.2 years). 330 patients received perioperative
antibiotics. Twenty patients (5.7%) who received no
antibiotics for specific reasons served as the control group.
Wound infections developed in 33 of 122 patients (27%) who received
benzylpenicillin, 17 of 88 patients (19.3%) who received
amoxicillin combined with
sulbactam and 25 of 120 patients (20.8%) who received
cefuroxime. Ten patients (50%) who did not receive
antibiotics developed
wound infections. Receiving no
antibiotics or
penicillin showed no benefit (P = 0.11). Those receiving
cefuroxime showed significantly lower incidence of
wound infections (P = 0.034; risk decreased by the factor 2.88). The use of
amoxicillin combined with
sulbactam showed the lowest rate of
wound infections (P = 0.018; risk decreased by the factor 3.46). The use of
amoxicillin combined with
sulbactam appears to be the most appropriate prophylactic
antibiotic followed by
cefuroxime in oral
microsurgical free flap reconstructions. These data may serve as a guide until a controlled multicenter prospective trial is performed comparing newer
antibiotics against current standards.