Osteocutaneous Free Flaps in Head and Neck Reconstruction: Infections and Outcomes after Short and Long Course Antibiotic Prophylaxis

Submitted by:

Kevin Chacko
University of Florida College of Medicine


Kevin Chacko


Microvascular free flaps remain the gold standard in head and neck reconstruction, with a success rate in the literature of about 95%. However, exposure to a clean-contaminated field due to disruption of the mucosal lining of the upper aerodigestive tract often predisposes patients undergoing free flap surgery to bacterial contamination and a high rate of surgical site infections (SSI). Prophylactic antibiotics have been established as beneficial in reducing the rate of SSI and other post-operative infections. The literature suggests that short and long course antibiotic prophylaxis do not have significant differences in infection rates in free flaps, with a short course preferred due to increased antibiotic stewardship. However, there are a lack of studies focusing on antibiotic prophylaxis duration specifically in osteocutaneous free flaps, which have been shown to have a higher rate of post-operative infection. Thus, the primary aim of this study is to identify infection rates in osteocutaneous free flaps after short and long course antibiotics. This study is a retrospective chart review of patients at our institution that underwent head and neck reconstruction with an osteocutaneous free flap between 2014 and 2022. Our study shows that the percentage of patients that experienced an infection within 30 days after reconstruction with an osteocutaneous free flap is 46%. The rate of SSI was 27%, pneumonia was 10%, sepsis was 9% and UTI was 4%. The rate of antibiotic complications, particularly Clostridium difficile infections, was 4%. SSI and other post-operative infections can increase medical costs, prolong hospital stays, and, in the case of cancer, can postpone the initiation of adjuvant therapy leading to an increased risk of recurrence. Consequently, this study is important in efforts to reduce infection rates and mitigate these negative effects.


To investigate the rates of various post-operative infections after short and long course antibiotics in head and neck reconstruction using osteocutaneous free flaps.

To determine predictive factors for surgical site infections after head and neck reconstruction using osteocutaneous free flaps.

To determine if there is a relationship between plate exposure and surgical site infection after head and neck reconstruction using osteocutaneous free flaps.