The effect of antibiotic prophylaxis duration on infection rates and outcomes after head and neck reconstruction with bony free flaps and hardware.

Background: Although the literature supports a shorter course of 24 h of prophylaxis after head and neck free flap reconstruction, studies supporting this duration do not differentiate between flap types. There is a paucity of evidence on the optimal duration of prophylaxis for osteocutaneous free flaps with hardware, which may have higher rates of post-operative complications compared to other free flaps. This study aimed to examine the effect of different lengths of antibiotic prophylaxis on surgical site infection (SSI) rates after head and neck reconstruction with osteocutaneous free flaps and hardware.

Methods: In this single-institution retrospective cohort study, 198 patients undergoing head and neck reconstruction with osteocutaneous free flaps and hardware were included. Prophylaxis duration varied: 93 patients received a short course (24-72 h), and 105 patients received a long course (>72 h).

Results: Thirty-nine percent of patients in the short course group and 33 % of patients in the long course group developed an SSI within 30 days after surgery (p = 0.460). Rates of hardware exposure within 6 months were 5 % for both groups (p > 0.999).

Conclusions: A shorter course of antibiotic prophylaxis did not result in a significant increase in SSI or hardware exposure compared to a longer course of prophylaxis in head and neck reconstruction with osteocutaneous free flaps and hardware. In complex head and neck reconstruction with osteocutaneous free flaps and hardware, a short course of prophylaxis may effectively minimize SSI.