The topic of this systematic review is one which is commonly heard in discussions between microbiologists and head and neck surgeons – what is the evidence for antibiotic prophylaxis in clean-contaminated free-flap cases, and crucially, how long should antibiotics be continued. Although the guidance for clean-contaminated head and neck cases in general is no more than 24 hours of antibiotics, in reality many clinicians continue them for longer than that in cases involving a free-flap.

This review aimed to examine the evidence for this higher-risk cohort. Five studies (n = 861) were included in the meta-analysis. Overall the risk of surgical site infection was significantly higher in the group receiving antibiotics for ≤ 24 hours compared with > 24 hours. This finding comes with a caveat however, as when the authors undertook multivariate analysis of antibiotic type used, in three of the five studies (697 patients), this difference was no longer significant.

The evidence with regards to clindamycin is more clear-cut. The review found that as a single agent it is significantly associated with higher postoperative complications. The conclusion drawn by this review is that, based on current evidence, the optimal duration for prophylaxis is ≤ 24 hours, but certainly there could be an argument for benefit of a longer duration. As with many systematic reviews of any topic, there remains a need for further research in order to reach a definitive conclusion! 

Antibiotic prophylaxis in clean-contaminated head and neck cases with microvascular free flap reconstruction: A systematic review and meta-analysis.
Haidar YM, Tripathi PB, Tjoa T, et al.
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Aileen Lambert

Great Ormond Street Hospital, London, UK.

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