Chen, S.Y., Chen, T.M., Dai, N.T., Fu, J.P., Chang, S.C., Deng, S.C., & Chen, S.G. (2011). Do antibacterial-coated sutures reduce wound infection in head and neck cancer reconstruction? European Journal of Surgical Oncology, 37, 300–304.

The primary aim of this study was to evaluate the effect of triclosan-coated sutures on cervical surgical wound infection rates. A secondary aim was to analyze the risk factors for wound infections in patients undergoing surgery for head and neck cancer.
 

The study sample was comprised of patients who were admitted to the Tri-Service General Hospital, National Defense Medical Center, in Taipei, Taiwan, from January 2007 to December 2009. The patients were admitted for tumor ablation after a diagnosis of head and neck cancer and they received reconstructive surgery after wide excision of the tumor. The patients also had an exploration of the cervical area for radical neck lymph node disection or vascular examination for microsurgical anastomoses.

Patients were randomized into the triclosan group or a control group by a flip of a coin.

All surgical procedures were the same. All patients received IV prophylactic antibiotics (1 g cephazolin every eight hours for three days and 80 mg of gentamycin every 12 hours for three days). Dressings were changed daily for wound care and evaluation. The closed suction neck drain was removed when there was less than 10 ml per day of drainage. Infections were inspected for and defined as local erythematous change in the sutured wound with purulent discharge, cervical wound dehiscence, or neck skin necrosis. Surgical wound and intra-oral flap sutures were removed two weeks post-surgery and evaluated for delayed healing defined as intra-oral wound dehiscence and surgical complications, such as flap necrosis, intra-oral flap dehiscence, oral-cervical fistula, and neck wound infection.

The total sample was 241 participants.

Mean age in the triclosan group was 53.6 years (SD = 9.8); the mean age in the control group was 51.1 years (SD = 11.3).

Males made up 93.4% of the sample; females made up 6.6%.

138 patients were stage T1 or T2 (58 in the triclosan group; 80 in the control group) and 103 were stage T3 or T4 (54 in the triclosan group; 49 in the control group)

67 patients had prior head and neck reconstruction (29 in the triclosan group; 38 in the control group), 91 had preoperative radiotherapy (46 in the triclosan group; 45 in the control group), 55 had diabetes (30 in the triclosan group; 25 in the control group), 219 underwent free flap transfer (102 in the triclosan group; 117 in the control group), flap sizes in the triclosan group were an average of 81 cm² (+ 57.9) and 72.7 cm² (+ 56.4) in the control group, and the length of stay for participants in the triclosan group was 35.3 days (+ 14.3) and 35.9 days (+ 21) in the control group.
 

A single-site inpatient setting in Taipei, Taiwan
 

Active treatment

Randomized, controlled trial

Thirty-six patients incurred infections, 17 in the triclosan group and 19 in the control group (p = 1.0). Risk factors for postoperative cervical wound infection included stages T3 and T4 (OR = 3.09, 95% CI [1.39, 6.87], p = 0.006); diabetes (OR = 2.01, 95% CI [0.88, 4.58], p = 0.098); delayed healing of intra-oral wound (OR = 5.82, 95% CI [2.66, 12.77], p < 0.001). Patients with infections had a statistically significantly longer length of stay (56.4 + 27.2 days) compared to no infection (32 + 13 days).

There was no statistically significant difference in infection rates between patients who received triclosan-coated sutures and controls. Advanced tumor stage, delayed intra-oral flap healing, and oral cavity contamination by normal flora were risk factors for infection.

Keeping the surgical site clean and clear from contamination is essential for infection prevention of surgical sites in patients with head and neck tumors. Study findings did not show a benefit with use of triclosan coated sutures in the surgical procedure.