The Impact of Postoperative Antibiotics on Outcomes Following Segmental Resection and Microvascular Reconstruction for Mandibular Osteoradionecrosis.

Abstract

The optimal intravenous (IV) antibiotic regimen following definitive surgical treatment for mandibular osteoradionecrosis (ORN) is unknown. This study evaluated the effect of culture-directed IV antibiotics (based on intraoperative cultures) on early wound complications, including surgical site infections (SSIs) and antibiotic duration on long-term wound healing (healing ≤ 2 months without subsequent complications). Retrospective review of flap reconstruction for ORN (2009-2022, N = 44, 70% free flaps, 30% pedicled). Postoperative antibiotics were culture-directed (25 patients) or empiric (19); the SSI rate was lower in the culture-directed group (0% vs. 26.3%, p = 0.01). Twenty-two patients received short-course (mean 9 days) and 22 long-course (mean 43 days) IV antibiotics postoperatively. During follow-up (mean 5.7 years), these groups had similar rates of long-term wound healing (50% vs. 36%, p = 0.54). In this series, patients who received culture-directed IV antibiotics postoperatively had zero SSIs. The rate of long-term wound healing was not affected by the antibiotic duration.