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May 1992

Prophylactic Antibiotics for Head and Neck Surgery With Flap Reconstruction

Author Affiliations

From the University of Pittsburgh (Pa) School of Medicine, Department of Otolaryngology, Eye and Ear Institute of Pittsburgh (Dr Johnson and Ms Wagner); the Department of Otolaryngology, Ohio State University School of Medicine, Columbus (Dr Schuller); the Division of Head and Neck Surgery, University of Cincinnati (Ohio) Medical Center (Dr Gluckman); the Department of Otolaryngology, University of Arkansas for Medical Science, Little Rock (Dr Suen); and the Department of Otolaryngology, University of California, San Francisco (Dr Snyderman).

Arch Otolaryngol Head Neck Surg. 1992;118(5):488-490. doi:10.1001/archotol.1992.01880050034008

• The leading cause of postoperative morbidity in patients undergoing major head and neck surgical procedures is postoperative infection. This prospective randomized multi-institutional clinical trial was designed to compare the effectiveness of clindamycin phosphate and high-dose cefazolin sodium therapy in preventing postoperative wound sepsis in patients undergoing contaminated head and neck surgical procedures in which flap reconstruction was required. Either clindamycin phosphate (900 mg) or cefazolin sodium (2 g) therapy was instituted intravenously prior to surgery and continued every 8 hours, for a total of 24 hours. The patients received postoperative follow-up, and the wounds were graded according to the worst condition observed. One hundred cases were evaluated. Fifty-one patients received clindamycin and 49 patients received high doses of cefazolin; wound infection developed in 10 patients (19.6%) and 11 patients (21.6%), respectively. This difference was not statistically significant. The average duration of surgery was approximately 8 hours for both the infected and the noninfected groups of patients. High-dose cefazolin and clindamycin have similar efficacy when administered prophylactically under these circumstances. Reconstruction with free vascularized tissue may aid in reducing postoperative wound infection.

(Arch Otolaryngol Head Neck Surg. 1992;118:488-490)