{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T05:06:01Z","timestamp":1774242361769,"version":"3.50.1"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Backgrounds<\/jats:title>\n                    <jats:p>Free flap reconstruction has become the standard of care in the repair of complex defects of the head and neck; however, surgical site infection remains a key area for improvement. This study aims to better understand the risk factors for surgical site infection in head and neck free flap reconstruction and gain insight into antibiotic prophylaxis choices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study reviews data from 100 cases across a 5\u2010year period. Univariate and multivariate analyses have been employed to elucidate statistically significant associations, examining surgical site infection, potential risk factors and other post\u2010operative markers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A surgical site infection developed in 32.0% of cases, with an average onset of 11.3\u2009days post\u2010operation. Preoperative anaemia (OR: 3.259) and a prophylactic antibiotic duration of \u2264\u200924\u2009h (OR: 3.010) were found to be independently significant risk factors for infection. Furthermore, surgical site infection was found to significantly increase unplanned returns to theatre (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.001), complete flap failure (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005) and length of stay (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026). The results also suggest that a 48\u2010h prophylaxis duration may be optimal, with no significant difference in infection rate at this cut\u2010off point.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>To the author's knowledge, this is the first paper to establish preoperative anaemia as an independently significant risk factor for surgical site infection in head and neck free flap operations. This study also finds the Australian guidelines' recommendation of \u2264\u200924\u2009h of antibiotic prophylaxis to be potentially inadequate in effectively controlling surgical site infection following head and neck free flap reconstruction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70512","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:35:42Z","timestamp":1770899742000},"page":"619-626","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Site Infection in Microvascular Free Flap Reconstruction of the Head and Neck: An Analysis of Risk Factors"],"prefix":"10.1111","volume":"96","author":[{"given":"Marco","family":"Stocca","sequence":"first","affiliation":[{"name":"Sydney Medical School Sydney University  New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascalino","family":"Romeo","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Westmead Hospital  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2348-9297","authenticated-orcid":false,"given":"Yasiru Gehan","family":"Karunaratne","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Westmead Hospital  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bishoy","family":"Soliman","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Westmead Hospital  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas C.","family":"Lam","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences Macquarie University  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huang\u2010Kai","family":"Kao","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Chang Gung Memorial Hospital &amp; Chang Gung University College of Medicine  Taoyuan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4995-896X","authenticated-orcid":false,"given":"Frank","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Sydney Medical School Sydney University  New South Wales Australia"},{"name":"Department of Plastic and Reconstructive Surgery Westmead Hospital  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21100"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2020.08.126"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2020.102392"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27417"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40463-017-0206-2"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-019-03078-6"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2019.102276"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23473"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13092109"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10156-010-0108-y"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2015.0513"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26837"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2020.214"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anl.2008.10.005"},{"key":"e_1_2_10_16_1","unstructured":"Therapeutic Guidelines Surgical Antibiotic Prophylaxis for Specific Procedures Therapeutic Guidelines Limited https:\/\/tgldcdp\u2010tg\u2010org\u2010au.ezproxy.library.sydney.edu.au\/viewTopic?etgAccess=true&guidelinePage=Antibiotic&topicfile=surgical\u2010antibiotic\u2010prophylaxis\u2010procedures&guidelinename=Antibiotic&sectionId=toc_d1e2024#toc_d1e2024."},{"key":"e_1_2_10_17_1","unstructured":"World Health Organization Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity (World Health Organization 2011) https:\/\/apps.who.int\/iris\/handle\/10665\/85839."},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11739\u2010012\u20100802\u20100"},{"key":"e_1_2_10_19_1","unstructured":"National Healthcare Safety Network Surgical Site Infection Event (SSI)(Centers for Disease Control and Prevention 2026) https:\/\/www.cdc.gov\/nhsn\/PDFs\/pscManual\/9pscSSIcurrent.pdf."},{"key":"e_1_2_10_20_1","unstructured":"\u201cThe Jamovi Project \u201dJamovi Version 2.3.26 https:\/\/www.jamovi.org."},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/lio2.410"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003489416672871"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2013.01.007"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31812e017a"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/bioengineering9110636"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1997.01430330057009"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1997.01430330063010"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2008.08.018"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2021.11.002"},{"key":"e_1_2_10_30_1","first-page":"62","article-title":"Infective Complications After Free Flaps Reconstruction in Patients Affected by Head and Neck Cancer Our Experience on 77 Cases","volume":"89","author":"Orabona G. 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