Articles | Volume 7, issue 3
Original full-length article
10 Jun 2022
Original full-length article |  | 10 Jun 2022

Osteocutaneous-flap-related osteomyelitis following mandibular reconstruction: a cohort study of an emerging and complex bone infection

Clément Javaux, Clémentine Daveau, Clotilde Bettinger, Mathieu Daurade, Céline Dupieux-Chabert, Fabien Craighero, Carine Fuchsmann, Philippe Céruse, Arnaud Gleizal, Nicolas Sigaux, Tristan Ferry, Florent Valour, and the Lyon BJI study group

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Cited articles

International Consensus Meeting (ICM): Second International Consensus Meeting on Musculoskeletal Infection, Part II: Hip and knee,, last access: 27 May 2022. 
Becker, G. D., Parell, J., Busch, D. F., Finegold, S. M., and Acquarelli, M. J.: Anaerobic and aerobic bacteriology in head and neck cancer surgery, Arch. Otolaryngol., 104, 591–594,, 1978. 
Benatar, M. J., Dassonville, O., Chamorey, E., Poissonnet, G., Ettaiche, M., Pierre, C. S., Benezery, K., Hechema, R., Demard, F., Santini, J., and Bozec, A.: Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases, J. Plast. Reconstr. Aes., 66, 478–482,, 2013. 
Bourget, A., Chang, J. T. C., Wu, D. B.-S., Chang, C. J., and Wei, F. C.: Free flap reconstruction in the head and neck region following radiotherapy: a cohort study identifying negative outcome predictors, Plast. Reconstr. Surg., 127, 1901–1908,, 2011. 
Cannon, R. B., Houlton, J. J., Mendez, E., and Futran, N. D.: Methods to reduce postoperative surgical site infections after head and neck oncology surgery, Lancet Oncol., 18, e405–e413,, 2017. 
Short summary
We describe 48 osteocutaneous-flap-related osteomyelitis cases, mostly presenting with early, local signs of infection and/or bone exposure. Main pathogens were Gram-negative bacilli, streptococci, S. aureus, enterococci, and anaerobes, justifying a broad-spectrum empirical antimicrobial therapy. Despite surgery and a 3-month antimicrobial therapy, a 50 % failure rate was recorded, associated with a delayed infectious disease specialist referral and advocating for multidisciplinary management.