Aleksandar Stojanovic, Christine Jacobson, Klaus W. Gratz, Jan Samuel Schenkel, Martin Rücker and Thomas Gander
Background: Postoperative infections and wound complications are among the main complications of any surgical treatment. Knowledge of patient-specific factors in cases of wound healing disorder, which can ultimately lead to failure of fixation, would allow such complications to be counteracted.
Methods: A search of operation records for the period 2005 to 2010, for mandibular fractures treated by open reduction and internal fixation, identified 450 suitable patients. Patient-specific details, such as age, gender, immunosuppression status (diabetes and drug immunosuppression), smoking status (self-declaration), alcohol consumption status (self-declaration), location of the fracture (after Miloro et al.), and the circumstances of the accident, if applicable, were recorded and categorised. As postoperative complications, wound dehiscence, infections related to loosened osteosynthesis material, pseudarthrosis, and osteomyelitis were examined and documented.
Results: Of the total number of patients, 348 (77.3%) were male and 102 (22.7%) were female, with a median age of 34.3 years. Thirty-eight patients showed wound healing complications (8.4%). Of these, 14 presented with wound dehiscence (3.1%), 4 with osteomyelitis (0.8%), 13 with pseudarthrosis (2.8%), and 7 suffered from infections related to osteosynthesis material (1.5%). The most common fractures were in the paramedian and median region (n=259, 37%), followed by the ascending branch (n=197, 28.1%) and the angle of the mandible (n=172, 24.6%). The most common causes of injury (where they could be determined) were assaults (33.6%), followed by falls (24.9%) and traffic accidents (15.6%). Twenty-seven (6%) patients were immuno-compromised, largely due to diabetes type I or II. In addition, 152 (33.8%) patients were smokers with a consumption of more than 5 pack-years. Regular, i.e. daily, alcohol consumption was recorded in 31 (6.9%) patients. In the treatment of wound healing disorders, three treatment modalities could be distinguished: local therapy with irrigation and close followup (nine cases: eight of wound dehiscence and one infection related to loosened osteosynthesis material), local wound therapy (curettage) and extension of antibiotics (seven cases: six of wound dehiscence and one of pseudarthrosis), and surgical revision with re-osteosynthesis and prolonged antibiotics (21 cases: 4 of osteomyelitis, 12 of pseudarthrosis, and 5 infections related to loosened osteosynthesis material).
Conclusions: In our study, only the regular consumption of alcohol was associated with a significantly increased risk of wound healing failure. In immuno-compromised patients and patients with regular nicotine consumption, a trend towards this result was observed. Although one might expect a decreased potential for healing with increasing age, we found no statistical relationship between postoperative infection and age. In our patient population, antibiotics were administered in each case for a period of 5 to 7 days.
