Risk Factors for Surgical Site Infection in Patients Undergoing Free and Pedicled Myocutaneous Flap Reconstruction After Oral Cancer Resection

Abstract

The aim of the study was to investigate risk factors for surgical site infection (SSI) at the recipient site in oral cancer resection surgery with neck dissection and reconstruction using a free or pedicled myocutaneous flap. Eighty-eight patients who underwent this procedure composed a nonrandomized retrospective cohort. Recipient site SSIs occurred in 27 patients (30.7%). In multivariate analysis, flap necrosis (partial or total; P=.003; odds ratio [OR]=12.8) and preoperative hypoalbuminemia (P=.025; OR=3.9) were independent risk factors for recipient site SSI. In an analysis restricted to flap survival cases, free flap (vs pedicled flap; P=.026; OR=25.0) and preoperative hypoalbuminemia (P=.014; OR=11.0) were significant risk factors for recipient site SSI. These results suggest that different preoperative nutritional interventions, such as a diet enriched with energy and protein, oral nutritional supplements, and, in patients with compromised swallow, enteral tube feeding or parenteral nutrition, could be important to decrease the frequency of recipient site SSIs. Pedicled and free flaps might result in SSIs for different reasons. Partial necrosis occurred more often with pedicled flaps than with free flaps and it might be important to use different techniques to decrease skin flap necrosis to lower the rate of SSIs.