RESUMO
(1) Background: Healthcare-associated infections (HAIs) after head and neck free-flap reconstruction are a common postoperative complication. Risk factors for HAIs in this context and their consequences have not been adequately described. (2) Methods: Ongoing prospective multicentre study between 02/2019 and 12/2020. Demographic characteristics and outcomes were analysed, focusing on infections. (3) Results: Forty out of 65 patients (61.54%) suffered HAIs (surgical site infection: 52.18%, nosocomial pneumonia: 23.20%, bloodstream infection: 13% and urinary tract infection: 5.80%). Methicillin-resistant Staphylococcus aureus (MRSA) and resistant Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter cloacae were the most frequently implicated. The significant risk factors for infection were: previous radiotherapy (Odds ratio (OR): 5.42; 95% confidence interval (CI), 1.39-21.10), anaemia (OR: 8.00; 95% CI, 0.96-66.95), salvage surgery (eight out of eight patients), tracheostomy (OR: 2.86; 95% CI, 1.01-8.14), surgery duration (OR: 1.01; 95% CI, 1.00-1.02), microvascular reoperation <72 h (eight/eight) and flap loss (eight/eight). The major surgical complications were: a need to reoperate (OR: 6.89; 95% CI, 1.42-33.51), prolonged hospital admission (OR: 1.16; 95% CI, 1.06-1.27) and delay in the initiation of postoperative radiotherapy (OR: 9.07; 95% CI, 1.72-47.67). The sixth month mortality rate in patients with HAIs was 7.69% vs. 0% in patients without HAIs (p = 0.50). (4) Conclusions: HAIs were common after this type of surgery, many of them caused by resistant microorganisms. Some modifiable risk factors were identified. Infections played a role in cancer prognosis by delaying adjuvant therapy.
RESUMO
El tumor maligno de la vaina nerviosa periférica (TMVNP) es un tumor mesenquimal raro que surge de las células de la vaina del nervio periférico. Tiene un comportamiento agresivo. Generalmente se presenta en extremidades y tronco, siendo su presencia en cabeza y cuello muy poco frecuente. Reportamos un caso raro de TMVNP del nervio dentario inferior en su trayecto intraóseo mandibular, no asociado a neurofibromatosis
Malignant peripheral nerve sheath tumour (MPNST) is a rare mesenchymal tumor that arises from peripheral nerve sheath cells. It has aggressive behavior. It usually occurs in extremities and trunk, being its presence in head and neck very infrequent. We report a rare case of TMVNP of the inferior dental nerve in its mandibular intraosseous pathway, not associated with neurofibromatosis
