A ten-year experience of multiple flaps in head and neck surgery: how successful are they?

Ablative surgery in the head and neck often results in defects that require free flap reconstruction. With improved ablation/reconstructive and adjuvant techniques, improved survival has led to an increase in the number of patients undergoing multiple free flap reconstruction. We retrospectively analyzed a single institution's 10-year experience (August 1993 to August 2003) in free flap reconstruction for malignant tumors of the head and neck. Five hundred eighty-two flaps in 534 patients were identified with full details regarding ablation and reconstruction with a minimum of 6-month follow-up. Of these 584 flaps, 506 were for primary reconstruction, 50 for secondary reconstruction, 12 for tertiary reconstruction, and 8 patients underwent two flaps simultaneously for extensive defects. Overall flap success was 550/584 (94%). For primary free flap surgery, success was 481/506 (95%), compared with 44/50 (88%) for a second free flap reconstruction and 9/12 (75%) for a third free flap reconstruction ( P < 0.05). Eight extensive defects were reconstructed with 16 flaps, all of which were successful. More than one free flap may be required for reconstruction of head and neck defects, although success decreases as the number of reconstructive procedures increases.

The pattern of burn infection in the Singapore National Burns Centre.

As part of the multi-pronged strategy in the fight against burn infection, we conducted a retrospective study of the pattern of infection in our burn patients for a period of 15 months from January 1993 to March 1994. We studied culture and sensitivity reports to determine the incidence of each organism, their antibiotic sensitivity patterns and the time interval between the burns injury and the appearance of these organisms. Organisms like methicillin-resistant Staphylococcus aureus (MRSA) and multiply-resistant Acinetobacter baumannii constituted a problem in our patients. Other organisms that were isolated from our patients included Pseudomonas aeruginosa, Enterobacter species and Klebsiella species. The infection control measures in our burns centre are aimed at combating the spread of gram-positive and gram-negative organisms. This study has helped to influence our antibiotic administration policy for treating infection in our centre based on the sensitivity patterns of the prevailing flora.

Vancomycin-resistant Enterococcus in the Singapore National Burns Centre: a case report.

Vancomycin-resistant Enterococcus (VRE) is becoming an important cause of nosocomial infections. An outbreak of VRE in a burns unit, if it ever occurs, will be a catastrophe as vancomycin-resistance can potentially be transferred to other organisms like methicillin-resistant Staphylococcus aureus. We report a case of VRE in our burns centre in which it was detected and the patient isolated from other patients early. Measures to control the occurrence of VRE include the restriction of the use of vancomycin and the practice of other established infection-control measures.

Emergence of a multiply-resistant strain of Acinetobacter in a burns unit.

Multiply-resistant Acinetobacter has emerged as an important organism in the Burns Unit of the Singapore General Hospital. From November 1990 onwards, a strain that was resistant to all antibiotics except Polymyxin B emerged in the Burns Unit. We present two cases where the Acinetobacter isolated was resistant to all antibiotics including Polymyxin B. These cases serve as an important reminder to adhere to strict infection control procedures.