Wound infections in head and neck cancer surgery

Wound infections (WIs) are the main cause of post-surgical morbidity in hea d and neck surgery. They arise with an especially immunocompromised predisp osition and mainly involve oropharyngeal flora bacteria. However, the asses sment of the incidence of these infections differs in the literature (0 to 87%). This in part accounts for the lack of a real consensus as to the defi nition (do all mucocutaneous fistulae attest to WIs?). For this reason, the analysis of their risk factors and the means of the prevention is difficul t. In class I surgery, the incidence of WIs ranges 0 to 6%. In this case, a ntiobioprophylaxis does not seem to be justified.:ln surgery opening the mu cosa, it is difficult to classify, the surgical procedures in Altemeier's c lasses 2 and 3. There are many arguments, in particular physiopathological arguments, to consider that the contamination of surgical bed of surgery do es continue after the operation. The incidence of WIs varies widely from on e study to the next. Without antibiotic prophylaxis, from 40 to 87% WIs are observed. With preventive antibiotherapy, the incidence ranges between 3.4 to 47%. Various risk factors have been described, in particular: tumour si ze and node extension, tracheotomy prior to surgery. Four multi-Sector stud ies have shown, in multivariate analysis, totally different risk factors. T he prevention of these WIs is currently based on hospital hygiene rules and antibiotic prophylaxis;. The optimum conditions have still not been determ ined Reliable data to define, the incidence and risk factors of these WIs a re missing. New prospective studies are definitely required.