Neal Koss

A Meta-Analysis of Prophylactic Antibiotics in Head and Neck Surgery

Although it is generally agreed that prophylactic antibiotics are necessary for the prevention of postoperative wound infection, the choice of antibiotic regimen is controversial. In an attempt to determine the most effective antibiotic regimen, a meta-analysis of published clinical trials of prophylactic antibiotics for head and neck surgery was undertaken. The meta-analysis revealed a relative difference in infection rates of 43.7 percent in favor of the use of antibiotics versus placebo, of 8.3 percent in favor of multiple antibiotics versus a single antibiotic, of 13.7 percent in favor of multiple antibiotics versus cefazolin, and of 4.1 percent in favor of multiple-day prophylaxis versus single-day prophylaxis. This meta-analysis suggests that a 1-day course of clindamycin may be the most effective prophylactic antibiotic regimen for head and neck surgery.

The current use of prophylactic antibiotics in plastic and reconstructive surgery.

A questionnaire distributed to plastic surgeons to determine their patterns of usage of systemic prophylactic antibacterial agents was answered by 1,025 respondents (73.7 percent). The patterns of usage among the respondents were determined for 29 circumstances and operations for the time of administration, and as influenced by 11 modifying factors. The data present the patterns of antibacterial use by plastic surgeons at this time.

Denervation supersensitivity and the delay phenomenon.

We have reviewed the denervation supersensitivity-AV shunt hypothesis (explaining the delay phenomenon) and assessed the contribution of each of the two components of denervation supersensitivy to delay. We concluded that adrenergic denervation supersensitivity contributes little to the delay phenomenon. We propose a new hypothesis, based on the effects of prolonged vascular smooth muscle relaxation in the precapillary arterioles, to explain the delay phenomenon.

The undelayed Mütter flap in head and neck reconstruction

Twenty-one mastoid-occiput-based shoulder flaps have been used to reconstruct patients with head and neck cancer. When the tip of the flap does not extend beyond the midclavicle, this flap can safely be elevated and transferred into its final position without delay procedures. Not requiring secondary sectioning and implantation, the Mütter flap can successfully be used to reconstruct multiple defects within its arch. Its utility thus rivals the more commonly used medially based deltopectoral flap and forehead flap.