ArticleJPRAS open2026
Management of post-operative pseudomonas aeruginosa infection in head and neck free flap patients: Systematic review and case series.
Article in JPRAS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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8 authors.
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Abstract
Introduction/Aims: Pseudomonas aeruginosa (PA) is isolated in up to 12% of post-operative head and neck cancer patients, capable of surgical site tissue invasion triggering acute inflammation, thrombus formation, and localized microcirculatory collapse. This may result in flap failure and delay post-operative radiotherapy due to extended hospital stays. This report reviews literature on acetic acid washouts as adjunctive treatment for post-surgical PA infection and presents a single-centre case series. Methods: A systematic review protocol was registered with PROSPERO, and a comprehensive literature search on acetic acid use in PA infection was conducted. A retrospective single-centre review of head and neck patients undergoing ablative and reconstructive surgery with microvascular free tissue transfer (2020-2023) was performed. Patients with clinical and biochemical evidence of PA infection received 2-3 daily bedside washouts with 0.05% acetic acid for 7-14 days, alongside intravenous antibiotics. Results: Six patients with post-operative PA infection were identified. Acetic acid washouts were administered for 1-2 weeks alongside IV antibiotics based on susceptibility testing. Four patients required return to theatre (mean days post-op=20.5; range=5-44). Post-operative inpatient stays ranged from 9 to 38 days. No flap failures or metal-work removals occurred. Our literature search found no comparable studies. Conclusions: Acetic acid is an easily available, non-toxic, inexpensive topical agent, with bedside washout courses costing £28-£84 per patient. This modest expense is outweighed by the substantial health and psychological benefits of avoiding flap failure. Its low side effect profile supports its use in managing PA-infected surgical sites post-operatively in head and neck cases.
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