Postoperative infections in craniofacial reconstructive procedures

The rate of, and possible risk factors for, postoperative craniofacial infe ction is unclear. To investigate this problem, we reviewed 349 cases of cra niofacial skeletal procedures performed from 1996 to 1999 at our institutio n. Infection rate was determined and correlated with the use of implants, o perative site, and cause of deformity. The inclusion criteria consisted of all procedures requiring autologous or prosthetic implantation in craniofac ial skeletal sites, as well as all procedures involving bone or cartilage r esection, osteotomies, debridement, reduction and/or fixation. Procedures t hat did not involve bone or cartilage surgery were excluded. The criteria f or diagnosis of infection included clinical confirmation and one or more of 1) intravenous or oral antibiotic treatment outside of the prophylactic su rgical regimen; 2) surgical intervention for drainage, irrigation, and or d ebridement; and 3) microbiological confirmation. Among the 280 surgical cas es that fit the inclusion criteria and had complete records, there were 23 cases of postoperative infection (8.2%). The most common site for postopera tive infection was the mandible (infection rate = 16.7%). Multiple logistic regression analysis revealed gunshot wound to be the most significant pred ictor of postoperative infection. Additionally, porous polyethylene implant ation through a transoral route was correlated with a significant risk of p ostoperative infection.