Major head and neck surgery with ablation of oral cancer, neck dissection and free flap reconstruction is a well-established part of maxillofacial surgery. These patients however already have significant co-morbidities and together with a long operation, large wounds open for a prolonged period and prolonged hospital stay are likely candidates for nosocomial infections. Tracheostomies and prolonged postoperative immobilisation only further raise the risks. Other considerations are the reconstructions with free flaps and communication between mouth and neck wounds. Antibiotics are thus routinely used. The prophylactic regime though is a matter of controversy. There are several studies from other specialities that suggest no significant difference in between the administration of only a single preoperative dose and a more prolonged course. In head and neck surgery, however, there are various regimes including one with the administration of antibiotics for five days postoperatively.

This is an excellent study from a large teaching hospital in Germany. They prospectively divide 75 consecutive patients that all had head and neck SCC. All patients underwent an oncological resection, neck dissection and free flap reconstruction. Patients were divided into three groups; group 1 had peri and postoperative antibiotic prophylaxis until postoperative day 5. Group 2 patients only received preoperative antibiotics with no postoperative antibiotics and finally, group three again received only preoperative antibiotics with no postoperative doses but had enhanced antiseptic measures. These included local measures such as tracheotomy stoma and wound cleaning. There was no change of staff, workplace or technique during the duration of the study. The authors report no significant differences in age, gender, ASA grading or complexity of the surgery. Their analysis confirmed a significant decrease in surgical site infections in patients that received postoperative doses till day five. This is an excellent study albeit with small numbers and is a timely reminder to check one’s own protocol. It might even stimulate a local audit.

Prospective comparison of perioperative antibiotic management protocols in oncological head and neck surgery.
Bartell A, Kamal M, Teichmann J, et al.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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