Facial Plastic and Microvascular Surgery, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Laryngoscope. 2024 Jan;134(1):166-169. doi: 10.1002/lary.30785. Epub 2023 Jul 4.
To report the microorganisms and their antibiotic sensitivity profile from tissue cultures and stains at the time of anterolateral thigh fascia lata (ALTFL) rescue flap for management of mandibular osteoradionecrosis (ORN).
Retrospective chart review of patients who underwent ALTFL rescue flap for native mandibular ORN between 2011 and 2022.
Twenty-six cases comprising 24 patients (mean age 65.4 years, 65.4% male) with mandibular ORN from whom tissue cultures and gram stain were obtained at the time of ALTFL rescue flap. 57.7% grew bacterial species, while 34.6% grew fungal species. Multibacterial speciation was noted in 26.9% of cultures. A combination of bacterial and fungal growth was also seen in 15.4% of cases. All gram-positive cocci (GPC) were pansensitive to antibiotics except for one case of Staphylococcus aureus, which was resistant to levofloxacin. Gram-negative bacilli (GNB) species were isolated in 50.0% of cases. All fungal growth was due to Candida species. No growth was noted in 23.1% of cases. Multidrug resistance was noted in 53.8% of cases when GNB was isolated.
We report 76.9% of our cases of mandibular ORN had microbial growth from tissue cultures obtained at the time of the ALTFL rescue flap. Fungal growth was noted in a substantial number of cases and should be obtained as a specimen when pursuing culture-driven antibiotic therapy. Most GPCs were pansensitive to antibiotics, while GNBs were often the harbinger of multidrug resistant mandibular ORN.
4 Laryngoscope, 134:166-169, 2024.
报告股前外侧阔筋膜（ALTFL）游离皮瓣用于治疗下颌骨放射性骨坏死（ORN）时组织培养物和染色标本中的微生物及其抗生素敏感性谱。
对 2011 年至 2022 年间接受 ALTFL 游离皮瓣修复原发性下颌骨 ORN 的患者进行回顾性图表审查。
26 例患者（平均年龄 65.4 岁，65.4%为男性）接受了 ALTFL 游离皮瓣修复下颌骨 ORN，在游离皮瓣修复时从这些患者中获得了组织培养物和革兰氏染色。57.7%的培养物中生长有细菌，34.6%的培养物中生长有真菌。26.9%的培养物中存在多种细菌。15.4%的病例中也观察到细菌和真菌的混合生长。所有革兰氏阳性球菌（GPC）对除金黄色葡萄球菌外的抗生素均具有泛敏感性，金黄色葡萄球菌对左氧氟沙星耐药。50.0%的病例中分离出革兰氏阴性杆菌（GNB）。所有真菌生长均归因于念珠菌属。23.1%的病例未发现生长。当分离出 GNB 时，53.8%的病例存在多重耐药。
我们报告了 76.9%的下颌骨 ORN 病例在 ALTFL 游离皮瓣修复时的组织培养物中存在微生物生长。相当数量的病例中存在真菌生长，在进行基于培养的抗生素治疗时，应获取该标本。大多数 GPC 对抗生素均具有泛敏感性，而 GNB 通常是多药耐药性下颌骨 ORN 的前兆。
4 Laryngoscope, 134:166-169, 2024.
