Recipient Site Infection Research Articles

Outcomes of dorsal nasal augmentation using costochondral graft.

To assess functional and aesthetic outcomes in patients having undergone dorsal nasal augmentation with costochondral graft in a tertiary care setting. The single-centre, retrospective, observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of patients who underwent dorsal nasal augmentation using costochondral graft between January 1, 2018, and December 31, 2022. Aesthetic outcomes in terms of patient satisfaction were assessed using Facial Appearance, Health-related Quality of Life and Adverse Effects scores. Data was analysed using SPSS 26. Of the 46 patients, 28(61%) were males and 18(39%) were females. The overall mean age was 28.39±9.13 years. Dorsal nasal deficiency occurred secondary to congenital causes in 12(26.1%) patients, trauma 19(41.3%) and prior surgery 15(32.6%). Postoperative complication rate was 7(15%); 3(6.5%) had recipient site infection and 2(4.3%) had rib graft resorption. Besides, 1(2.2%) patient reported pain 2 months postoperatively and 1(2.2%) had hypertrophic scarring. Patient satisfaction with the outcome was noted in all the 10 parameters analysed. Most commonly reported problem was that the nose was 'looking thick/swollen' by 12(26.1%) patients, but the issue resolved during 1-year follow-up. Costochondral graft was found to be an ideal material for dorsal nasal augmentation, with high patient satisfaction rate.

Outcomes of dorsal nasal augmentation using costochondral graft

Objective: To assess functional and aesthetic outcomes in patients having undergone dorsal nasal augmentation with costochondral graft in a tertiary care setting. Method: The single-centre, retrospective, observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of patients who underwent dorsal nasal augmentation using costochondral graft between January 1, 2018, and December 31, 2022. Aesthetic outcomes in terms of patient satisfaction were assessed using Facial Appearance, Health-related Quality of Life and Adverse Effects scores. Data was analysed using SPSS 26. Results: Of the 46 patients, 28(61%) were males and 18(39%) were females. The overall mean age was 28.39+9.13 years. Dorsal nasal deficiency occurred secondary to congenital causes in 12(26.1%) patients, trauma 19(41.3%) and prior surgery 15(32.6%). Postoperative complication rate was 7(15%); 3(6.5%) had recipient site infection and 2(4.3%) had rib graft resorption. Besides, 1(2.2%) patient reported pain 2 months postoperatively and 1(2.2%) had hypertrophic scarring. Patient satisfaction with the outcome was noted in all the 10 parameters analysed. Most commonly reported problem was that the nose was ‘looking thick/swollen’ by 12(26.1%) patients, but the issue resolved during 1-year follow-up. Conclusion: Costochondral graft was found to be an ideal material for dorsal nasal augmentation, with high patient satisfaction rate. Key Words: Costal cartilage, Patient satisfaction, Rhinoplasty.

The Value of a Co-surgeon in Microvascular Breast Reconstruction: A Systematic Review and Meta-analysis.

Using a co-surgeon model has been suggested to improve perioperative outcomes and reduce the risk of complications. Therefore, we evaluated if a co-surgeon model compared with a single microsurgeon model could decrease the surgical time, length of stay, rate of complications, and healthcare-associated costs in adult patients undergoing microvascular breast reconstruction (MBR). A comprehensive search was performed across PubMed MEDLINE, Embase, and Web of Science. Studies evaluating the perioperative outcomes and complications of MBR using a single-surgeon model and co-surgeon model were included. A random-effects model was fitted to the data. Seven retrospective comparative studies were included. Ultimately, 1411 patients (48.23%) underwent MBR using a single-surgeon model, representing 2339 flaps (48.42%). On the other hand, 1514 patients (51.77%) underwent MBR using a co-surgeon model, representing 2492 flaps (51.58%). The surgical time was significantly reduced using a co-surgeon model in all studies compared with a single-surgeon model. The length of stay was reduced using a co-surgeon model compared with a single-surgeon model in all but one study. The log odds ratio (log-OR) of recipient site infection (log-OR = -0.227; P = 0.6509), wound disruption (log-OR = -0.012; P = 0.9735), hematoma (log-OR = 0.061; P = 0.8683), and seroma (log-OR = -0.742; P = 0.1106) did not significantly decrease with the incorporation of a co-surgeon compared with a single-surgeon model. Incorporating a co-surgeon model for MBR has minimal impact on the rates of surgical site complications compared with a single-surgeon model. However, a co-surgeon optimized efficacy and reduced the surgical time and length of stay.

FACTORS CONTRIBUTING TO THE RISK OF SURGICAL SITE INFECTION AND SEPSIS FOLLOWING RECONSTRUCTIVE FLAP SURGERY

Introduction: Reconstructive flap surgery, vital for addressing defects in diverse body regions, is employed in post-cancer and traumatic wound reconstruction, yielding favorable outcomes. While minor complications are well-documented, systemic complications, particularly sepsis, remain underexplored. This systematic review fills the gap by investigating sepsis incidence and associated risk factors in reconstructive flap surgery, aiming to enhance understanding, prevent complications, and improve patient care. Method: The researchers in this study followed the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to ensure that their work met the required standards. This was done to ensure the precision and reliability of the conclusions derived from the research. Result: Our search produced 14 results. After looking at the titles and summaries, we found several papers that fit our criteria. At first, we excluded few articles because they were written in review and case report style. But after reading the full papers carefully, we included five papers in our final analysis. These papers included retrospective review study and retrospective studies. Conclusion: Postoperative sepsis and surgical site infections (SSIs) are significant challenges in reconstructive flap surgery, with a 2.1% sepsis incidence and identified risk factors including comorbidities, BMI, and ASA Score. Sepsis elevates 30-day mortality risk almost fivefold, emphasizing the need for preventive measures. Our study underscores the impact equivalence of SSIs and Major Postoperative Infections (MPIs) and recommends a 72-hour antibiotic prophylaxis duration in head and neck free flap surgery. Notably, preoperative recipient site infection in lower extremity tissue transfer influences graft outcomes, and longer operating time consistently predicts SSIs, necessitating strategic planning and comprehensive comorbidity management. Prospective studies are crucial for refining predictors and optimizing patient care in reconstructive flap surgery.

Influence of sarcopenia on postoperative complications in patients undergoing autologous microsurgical breast reconstruction: an inverse probability of treatment weighting analysis.

Sarcopenia is characterized by the loss of skeletal muscle mass and power. Preoperative sarcopenia may be associated with an increased risk of postoperative complications after autologous free-flap breast reconstruction surgery; however, this relationship is controversial. This study aimed to determine whether preoperative sarcopenia is associated with a high complication rate in patients undergoing autologous free-flap breast reconstruction. Patients who underwent autologous free-flap breast reconstruction at our hospital between 2019 and 2021 were included in the study. Data on significant complications requiring surgical intervention were retrospectively collected from the medical records. Sarcopenia was defined as having a skeletal muscle index value <41 cm2/m2. The skeletal muscle index was calculated by dividing the sum of the psoas and iliopsoas muscle areas at the level of the third lumbar vertebra by the patient's height in meters squared. The relationship between preoperative sarcopenia and postoperative complications was investigated using an inverse probability of treatment weighting (IPTW) analysis. Among the 203 participants, 90 (44.33%) had preoperative sarcopenia. The general patient characteristics were similar between the sarcopenia and non-sarcopenia groups after IPTW adjustment. Sarcopenia did not significantly increase the risk of flap failure or emergency surgery related to breast reconstruction before IPTW adjustment. However, after IPTW adjustment, the rates of recipient site infection and hematoma were significantly higher in participants with sarcopenia than in those without sarcopenia (p < 0.001 and p = 0.014, respectively). Preoperative sarcopenia may influence certain complications of autologous free-flap breast reconstruction surgery.

Primarni graft parcijalne debljine kože za pokrivanje mekotkivnih defekata šake i prstiju - ne oklevajte

Introduction: Hand injuries often result in soft tissue defects. The treatment of these defects belongs to the most difficult challenges in reconstructive surgery. There are numerous options for covering soft tissue defects, including flaps and skin grafts. Material and methods: This retrospective observational study included seventeen patients with 24 skin defects of the hand, who were treated by primary split-thickness skin graft (STSG) in a single center. The average follow-up period was 6 months. The age of the patients ranged from 36 to 80 years. The majority of patients (n=16) were males, and one patient was female. Skin defects varied in size from 7x8mm to 39x40mm. Primary goals were STSG survival, recipient site infection, and donor site morbidity. Secondary goals were cosmetic appearance and time needed for complete wound healing. Results: All 24 wounds healed successfully in a mean of 28,11±9,94 days. There were no graft infections. Partial graft loss occurred in one case. There was no major donor site morbidity reported. Six patients described the cosmetic result as good (score 3), 10 patients dde-scribed it as acceptable (score 2), and one patient described it as poor (score 1). Conclusion: Split thickness skin graft is an excellent option for immediate treatment of hand and finger skin defects. This method is simple , has less consequences than secondary grafts, requires minimum equipment and can sometimes be done in the emergency room, without hospitalization. Therefore, there is no need to be afraid of primary skin grafting.

Restarting Therapeutic Antibiotics Following Postoperative Prophylaxis in Head and Neck Microvascular Free Tissue Transfer.

To determine factors associated with restarting therapeutic antibiotics within 30 days of head and neck microvascular free tissue transfer (HN-MFTT). Retrospective study of consecutive HN-MFTTs performed from January 2015 to July 2020. Tertiary academic medical center. Thirty-day postoperative antibiotic use and post-HN-MFTT surgical and medical complications were assessed. Univariable analyses and multivariable logistic regression were used to evaluate risk factors associated with restarting antibiotics. overall 482 patients with 501 HN-MFTTs were stratified by duration of prophylaxis: ≤24 hours (n = 136, 27.1%), 25-72 hours (n = 54, 10.8%), and >72 hours (n = 311, 62.1%). Antibiotics were restarted in 199 patients (209 procedures, 42%). The most common indications for antibiotic reinitiation were flap recipient site infection (n = 59, 28%); hospital-acquired pneumonia (n = 44, 21%); and wound dehiscence, fluctuance, or change in quality of drain output (n = 44, 21%). Shorter antibiotic prophylaxis (≤24 hours) (odds ratio [OR], 1.95; 95% CI, 1.2-3.0; P = .003), osteocutaneous flaps (OR, 2.15; 95% CI, 1.3-3.4; P = .001), and prior immunotherapy/chemotherapy (OR, 2.29; 95% CI, 1.2-4.3; P = .01) were associated with reinitiation of antibiotics for surgical infections. Restarting antimicrobials for nosocomial infections was associated with aerodigestive defects (OR, 2.45; 95% CI, 1.1-5.2; P = .019), cardiovascular disease (OR, 3.00; 95% CI, 1.5-5.9; P = .001), and medical comorbidities approximated by American Society of Anesthesiologists class 3 or 4 (OR, 2.83; 95% CI, 1.5-5.4; P = .002). Aerodigestive reconstruction, 24-hour postoperative antimicrobial prophylaxis, American Society of Anesthesiologists class 3 and 4, prior chemotherapy/immunotherapy, cardiovascular disease, and osteocutaneous flaps are associated with reinitiation of antibiotics within 30 days of HN-MFTT.

Antibiotic Prophylaxis Prescribing Practice in Head and Neck Tumor Resection and Free Flap Reconstruction.

BackgroundAdherence to guidelines for antibiotic prophylaxis is often poor and is an important target for antimicrobial stewardship programs. Prescribing audits that suggested poor adherence to guidelines in a plastic surgery department led to a targeted education program to bring antibiotic prescriptions in line with hospital guidelines. We reviewed whether this intervention was associated with changed perioperative prescribing and altered surgical outcomes, including the rate of surgical site infections, specifically looking at clean-contaminated head and neck tumor resections with free flap reconstruction.MethodsA retrospective cohort study was performed on 325 patients who underwent clean-contaminated head and neck tumor resection and free flap reconstruction from January 1, 2013, to February 19, 2019. Patients were divided into 2 groups, those before (pre-intervention) and after (postintervention) the education campaign. We analyzed patient demographic and disease characteristics, intraoperative and postoperative factors, and surgical outcomes.ResultsPatients pre-intervention were prescribed longer courses of prophylactic antibiotics (median [interquartile range], 9 [8] vs 1 [1]; P < .001), more topical chloramphenicol ointment (21.82% vs 0%; P < .001), and more oral nystatin (36.9% vs 12.2%; P < .001). Patients postintervention had higher rates of recipient infections (36.11% vs 17.06%; P < .001) and donor site infections (6.94% vs 1.19%; P = .006).ConclusionsFollowing the education campaign, patients were prescribed shorter courses of prophylactic antibiotics, more of the recommended cefazolin-metronidazole regimen, and fewer topical antibiotics. However, patients also had a higher rate of surgical site infections.

Higher body mass index is a more important risk factor than sarcopenia for complications in reconstruction of the deep inferior epigastric perforator

BackgroundIn recent years, breast reconstruction using autologous tissue after breast cancer surgery has become a common procedure. This study investigated the association between the occurrence of complications in breast reconstruction using deep inferior epigastric perforator (DIEP) flaps and patient risk factors among Asian women. MethodsThis study included cases of breast reconstruction using DIEP flaps performed at our institution. We retrospectively investigated the relationship between preoperative and operative patient factors and postoperative complications by collecting data from medical records. Sarcopenia was also evaluated by calculating psoas muscle index from the area of the iliopsoas muscle at the level of the third lumbar vertebra using images from preoperative computed tomography. Postoperative complications were compared between a low-body mass index (BMI) group and a high-BMI group, defined using BMI values of <25 kg/m2 and ≥25 kg/m2, respectively. ResultsA total of 129 cases of breast reconstruction using DIEP flaps were included in this analysis. The frequency of postoperative complications was significantly higher in the high-BMI group, including for skin flap necrosis of the breast (p = 0.03), recipient-site infection (p = 0.03), and donor-site seroma (p = 0.003). Moreover, abdominal circumference correlated significantly with recipient-site infection (p = 0.01) and donor-site seroma (p = 0.002). Sarcopenia did not show significant correlations with any complications. ConclusionBMI was identified as a risk factor for the occurrence of postoperative complications in breast reconstruction using the DIEP flap, but sarcopenia was not.

Impact of body mass index on free DIEP flap breast reconstruction: A multicenter cohort study

Several patient-related factors have been identified with regard to the safety and efficacy of breast reconstructions. This study analyzed the largest series of microsurgical breast reconstructions in Germany using deep inferior epigastric perforator (DIEP) flaps, with a focus on the impact of patient body mass index (BMI). A total of 3911 female patients underwent 4561 free DIEP flap breast reconstructions across 22 different centers. The cases were divided into five groups using World Health Organization BMI criteria: underweight group (BMI <18.5 kg/m2), normal weight/ control group (BMI: 18.5-24.9 kg/m2), overweight group (BMI: 25-29.9 kg/m2), moderately obese group (BMI: 30-34.9 kg/m2), and severely obese group (BMI ≥ 35 kg/m2). Surgical complications were accounted for and the five BMI groups were then compared. Overall, there was no significant difference regarding the rate of partial- and total flap loss between all BMI groups (p>0.05). However, overweight and obese patients showed significantly higher rates of postoperative infections at the donor and recipient sites than the control group (donor site infections: overweight 0.6%; moderately obese 0.9%; severely obese 2.4% vs control 0.1%; all p<0.01; recipient site infections: overweight 0.5%; moderately obese 0.8%; severely obese 1.4% vs control 0.1%; all p<0.05). The rate of medical complications also differed significantly between groups, with the highest rates in moderately and severely obese women (moderately obese: 8.4%; severely obese: 13.0% vs. control: 5.1%; p<0.01). Our findings suggest that successful free tissue transfer can be achieved even in an underweight and severely obese population with acceptable risk for complications.

Oral recipient site infections in reconstructive surgery - impact of the graft itself and the perioperative antibiosis.

This study was designed to assess the influence of peri/post-operative antibiotic prophylaxis (POABP) and the reconstructive graft itself on recipient sites infections in head and neck surgery. In this retrospective cohort study, 322 consecutive patients with reconstructive surgery were investigated. The primary objective was to analyze the differences of commonly applied reconstructive grafts on the occurrence of oral recipient site infections. Moreover, differences of POABP regimes (namely: ampicillin/sulbactam, 2nd generation cephalosporins, clindamycin) and antibiotic alternatives were investigated. In addition, patients' length of in-hospital stay was analyzed in regard to reconstructive graft and POABP regime. The free radial forearm flap and split-thickness skin graft presented significantly less recipient site infections and shorter length of in-hospital stays (LOS) in comparison to further six reconstructive technique with pedicled tissue transfer or bone transfers. LOS was significantly shorter for patients with ampicillin/sulbactam than with 2nd generation cephalosporins as POABP. 91% of the harvested pathogens (n=193) were susceptible to the combination of 2nd and 3rd generation cephalosporins. Secondly, 92 out 113 (81%) harvested pathogens presented susceptibility to moxifloxacin. Smaller tissue transfers are less prone to infections of the recipient site and present low LOS. For an POABP regime, the combination of 2nd and 3rd generation cephalosporins presents substantial results in recipient site infections. In cases of allergy, potential pathogens show adequate susceptibility to moxifloxacin. A combination of 2nd and 3rd generation cephalosporins may be used to prevent recipient sites in head and neck surgery.

LEA 14. Outcomes After Split-Thickness Skin Grafting in Peripheral Artery Disease and Diabetic Foot Wounds in an Asian Population

The objective of this study was to review the outcomes after split-thickness skin grafting (SSG) of patients with peripheral artery disease and diabetic foot wounds in an Asian population. A retrospective review was conducted of 43 SSGs performed in patients from 2013 to 2018 in a single tertiary hospital. Patient and wound characteristics and outcomes were evaluated. Kaplan-Meier survival analysis was performed to evaluate subsequent ipsilateral ulcers, minor amputations, major amputations, and all-cause mortality rates. Within our study population, 72% were male, with a mean age of 65 years; 91% had diabetes mellitus, 54% had a previous minor amputation, and 7% had previous contralateral major amputations. For the foot wound recipient site, 23% had prior toe amputations; 56% had prior transmetatarsal amputations. All patients underwent negative pressure wound therapy before SSG, with a mean duration of 5.4 weeks (range, 2-12 weeks). At 1 week, recipient site uptake was 95%, with donor site infection at 5%. There were no complications of recipient site bleeding, infection, or nosocomial infections. At 1 year, subsequent ipsilateral ulcer development, minor amputation, major amputation, and all-cause mortality were 17%, 20%, 5%, and 13%, respectively. At 5 years, subsequent ipsilateral ulcer development, minor amputation, major amputation, and all-cause mortality were 49%, 52%, 14%, and 48%, respectively. Within our study population of Asian ethnicity, SSG in patients with peripheral artery disease and diabetic foot wounds confers good recipient uptake rates, with low rates of complications. Limb preservation rates were 95% at 1 year and 86% at 5 years.

A 20-year experience of immediate mandibular reconstruction using free fibula osteocutaneous flaps following ameloblastoma resection: Radical resection, outcomes, and recurrence

BackgroundThe mandible is an important structure that is located in the lower third of the face. Large mandibular defects after tumor resection cause loss of its function. This study assessed the outcomes and tumor recurrence after immediate mandibular reconstruction using a free fibula osteocutaneous flap following radical resection of ameloblastoma.MethodsThis is a retrospective non-randomized study of outcomes and tumor recurrence of all patients diagnosed with mandibular ameloblastoma from August 1997 until August 2017 (20 years) requiring free fibula osteocutaneous flap reconstruction at a single institution. The patients were identified through an electronic operative database; subsequently, their medical records and photo documentation were retrieved.ResultsTwenty-seven patients were included in this study. Eighteen patients were male, while nine were female. The majority of the patients (48.1%) were in their third decade of life when they were diagnosed with ameloblastoma. All of them underwent radical resection of the tumor with a surgical margin of 2 cm (hemimandibulectomy in cases with a large tumor) and immediate mandibular reconstruction with a free fibula osteocutaneous flap. Two patients required revision of a vascular anastomosis due to venous thrombosis postoperatively, while one patient developed a flap recipient site infection. The flap success rate was 100%. There was no tumor recurrence during a mean follow-up period of 5.6 years.ConclusionsMandibular ameloblastoma should be treated with segmental mandibulectomy (with a surgical margin of 2 cm) to reduce the risk of recurrence. Subsequent mandibular and adjacent soft tissue defects should be reconstructed immediately with a free fibula osteocutaneous flap.

Free Flap Outcomes of Microvascular Reconstruction after Repeated Segmental Mandibulectomy in Head and Neck Cancer Patients

This is the first study to investigate the impact of a second fibula flap or a soft tissue flap combined with bridging plate for a repeated segmental mandibulectomy reconstruction on flap outcomes in head and neck cancer patients. A retrospective comparative analysis (2007–2016) of 61 patients who underwent a second segmental mandibulectomy was performed. 20 patients underwent a fibula flap reconstruction whereas 41 had a soft tissue flap and plate reconstruction. No significant difference was seen in the operative time, total hospital stay, flap loss, re-exploration rates, plate exposure rate, or recipient site infection rate. On multivariate analysis, patients reconstructed with a soft tissue flap and bridging plate (odds ratio (OR) 3.997; 95% confidence interval (CI), 1.046–15.280, p = 0.043) and complications developed in previous surgery (OR 4.792; 95% CI, 1.120–20.493, p = 0.035) were shown to be independent predictors of a prolonged nasogastric tube dependence. The utilization of a soft tissue flap with plate is associated with comparative results of acute complication rate within 1 week, recipient site infection rate, and plate exposure rate to free fibula flaps alone. Free fibula flaps may result in a decreased risk for prolonged tube dependence compared to free soft tissue flap reconstructions.

Soft tissue free flap for reconstruction of upper extremities: A meta-analysis on outcome and safety.

The aim of this study was to evaluate outcome and safety of free flaps to the upper extremity by pooled, summarized rates, compared with the existing pooled results of the lower extremity from literature, and to improve the level of evidence in a meta-analysis. A literature search of PubMed and Embase was conducted addressing publications between January 2000 and April 2018. Publications were selected by inclusion/exclusion criteria on safety and outcome. Postoperative complications were statistically analyzed: flap loss, vessel thrombosis; recipient-site infection, hematoma, seroma, wound dehiscence, dysesthesia; donor-site morbidity. Two hundred and seventy-nine patients with 283 free flaps from 23 publications were extracted and eligible for this meta-analysis. The predominant donor site was the lower extremity (56%), with the anterolateral thigh flap as the major workhorse (30%). The summarized rate of total and partial flap loss was 6.0% (95% CI = 3.0-9.0%, PQ = 1.0000) and 8.0% (95% CI = 6.0-13.0%, PQ = 0.9973), respectively. The rate of arterial and venous thrombosis was 5.0% (95% CI = 3.0-9.0%, PQ = 0.9999) and 8.0% (95% CI = 9.0-37.0%, PQ = 0.9804), respectively. Complication rates of recipient site were: early infection with 7.0% (95% CI = 4.0-11.0%, PQ = 0.9788), hematoma with 6.0% (95% CI = 3.0-8.0%, PQ = 1.0000), seroma with 6.0% (95% CI = 4.0-10.0%, PQ = 0.9948), dehiscence with 7.0% (95% CI = 4.0-11.0%, PQ = 0.9988), and dysesthesia with 6% (95% CI = 4.0-10.0%, PQ = 0.9988). The rate of donor-site morbidity was 14% (95% CI = 8.0-21.0%, PQ = 0.0895). Soft tissue free flaps to the upper extremity have comparable success rates, but higher perioperative complication rates (e.g., partial flap loss, infection, and wound dehiscence) compared to the pooled data of lower extremity reconstruction from existing meta-analysis.

Study of efficacy and safety of noncultured, extracted follicular outer root sheath cell suspension transplantation in the management of stable vitiligo.

Noncultured, extracted follicular outer root sheath suspension (NC-EHF-ORS-CS) is a recently introduced technique for the treatment of stable vitiligo. To study the clinical efficacy of this technique and to determine the viability and cell composition of the suspension. Twenty-five patients with stable vitiligo were included in this prospective study. Fifty follicles were extracted from occipital scalp and were incubated with trypsin-ethylenediaminetetraacetic acid to separate outer root sheath cells. The cell suspension was filtered and centrifuged to obtain a cell pellet, which was resuspended and applied to the dermabraded recipient area. Cell viability of the suspension was assessed using trypan blue staining, and markers of keratinocyte stem cells (CD200) and melanocytes (S100) were evaluated using flow cytometry and immunocytochemistry, respectively. At 6 months, the mean (±SD) repigmentation was 52 ± 25.1%, and >75% repigmentation was seen in 8/25 (32%) patients. Mean percentage cell viability of the suspension was 80 ± 17.2% with a mean concentration of CD200 + and S100 + cells being 7.91 ± 8.68% and 9.93 ± 1.22% (n = 3), respectively. Recipient site infection was seen in 4 of 25 (16%) patients and a color mismatch in 11 of 25 (44%) patients. NC-EHF-ORS-CS is a useful minimally invasive therapy for vitiligo.

Literature Review of Criteria for Defining Recipient-Site Infection after Oral Oncologic Surgery with Simultaneous Reconstruction.

The lack of uniformity of criteria for defining recipient-site infection after oral oncologic surgery with simultaneous reconstruction is problematic despite numerous studies on this issue. This study aimed to investigate the difference in the criteria for defining recipient-site infection after oral oncologic surgery with reconstruction. A Medline search was performed via PUBMED using the following combinations of key terms that were tagged in the title, abstract, or both: "surgical site infection-head neck," "surgical site infection-oral cancer," "antibiotic prophylaxis-head neck," and "surgical site infection-oral carcinoma." Search results were filtered between 2005 and 2017. Articles in which there was no mention of the criteria for definition of surgical-site infection were excluded. The number of articles that met the inclusion criteria was 24. The lack of uniformity in the criteria for defining recipient-site infection in each article appeared to be attributable mainly to differences in whether an orocutaneous fistula and superficial incisional infection were regarded as recipient-site infection. Reconsideration of the categorization of orocutaneous fistula as infection, regardless of the etiology, and differentiation of superficial and deep incisional infections are necessary for correct assessment of recipient-site infection in oral oncologic surgery.

Osteocutaneous radial forearm free flap in nonmandible head and neck reconstruction.

The osteocutaneous radial forearm free flap (RFFF) is a versatile flap primarily used to reconstruct composite defects involving the mandible. The purpose of this study was to describe our experience with this flap for nonmandible reconstruction. All patients undergoing nonmandible osseous reconstruction with free-tissue transfer were reviewed. Patients with osteocutaneous RFFF reconstructions were evaluated. The retrospective review of all osteocutaneous RFFFs was performed from 1998 to 2014. One hundred forty-two nonmandible osseous reconstructions were performed. Twenty-five patients underwent nonmandible osteocutaneous RFFF reconstruction. Eleven patients failed previous nonmicrovascular reconstruction. Reconstruction was for defects of the: palatomaxillary complex (n = 15), orbitomaxillary complex (n = 4), nasomaxillary complex (n = 4), larynx (n = 1), and clavicle (n = 1). There were no flap compromises. Postoperative complications included: 2 partial intraoral dehiscences; 1 recipient-site infection; and 1 seroma. Eight reconstructions required secondary procedures to improve functional and/or cosmetic outcomes. The osteocutaneous RFFF is a robust flap that can be used to reconstruct composite defects involving bone and soft-tissue beyond the mandible.

Surgical Site Infections in Patients Receiving Osteomyocutaneous Free Flaps to the Head and Neck. Does Choice of Antibiotic Prophylaxis Matter?

The most appropriate prophylactic antibiotic for clean-and-contaminated head and neck osteomyocutaneous free flap (OFF) tissue transfer procedures is unclear. The purpose of this study was to determine whether the choice of perioperative antibiotic was related to recipient surgical site infection (SSI) in patients receiving an OFF to the head and neck. This retrospective cohort study evaluated SSI in relation to the perioperative antibiotic received from July 2010 through October 2013 at a tertiary care medical center. Minimum follow-up was 6months. SSI was defined by the Centers for Disease Control and Prevention wound infection criteria. Perioperative antibiotic selected, duration of use, OFF performed, medical comorbidities, and SSIs were recorded and analyzed. One hundred two patients (64 men, 38 women) met the inclusion criteria. Forty patients developed an SSI. Analysis of variance showed that age (P= .64), gender (P= .97), use of alcohol (P= .87), final pathology (P= .3), cardiovascular disease (P= .33), and diabetes mellitus or immune dysfunction (P= .95) did not have a significant association with the development of a postoperative wound infection. On univariate analysis, non-head and neck primary malignancies showed a significant risk for SSI (P= .03), with previous head and neck surgery (P= .05) and oral tobacco use (P= .06) having trends for increased risk of SSI. Clindamycin antibiotic was strongly associated with the development of an SSI, with 50% of that cohort developing a recipient SSI (odds ratio= 7.0; P < .002), regardless of duration of use. The rate of development of a recipient SSI with cefazolin was 25% and that with ampicillin plus sulbactam was 19%. A statistically relevant number of patients who developed a recipient SSI received clindamycin as perioperative antibiotic prophylaxis. An antibiotic regime other than clindamycin should be considered in patients with an allergy to penicillin or cephalosporin who are undergoing an OFF procedure to the head and neck.

Complications and Difficult Cases: Case of Two Consecutive Recipient Site Infections during the Inflammatory Phase of Wound Healing after Follicular Unit Extraction

Complications and Difficult Cases: Case of Two Consecutive Recipient Site Infections during the Inflammatory Phase of Wound Healing after Follicular Unit Extraction