Introduction: Seroma formation is a serious postoperative complication. Since the management algorithms available in the literature are scarce, we aimed to analyze our experience with postoperative seroma in order to identify indicators for revisional surgery and propose recommendations for management. Methods: This retrospective study included all patients with postoperative seroma treated in a tertiary university hospital from 2008 to 2020. Patients’ demographics, medical history, and seroma treatment details were recorded and analyzed. Results: Overall, 156 patients were included: 41% were initially treated through needle aspiration, with 61% eventually undergoing surgical treatment for postoperative seroma. Comorbidities, such as heart failure and coronary heart disease, were significantly associated with an increased need for revisional surgery (p < 0.05). Both a duration of >40 days of repeated needle aspirations and drain re-insertions were significantly correlated with an increased risk for revisional surgery (p < 0.05). Conclusion: Patients requiring seroma aspiration should be counseled on surgical treatment sooner rather than later, as prolonged aspiration time (over 40 days) greatly increases the risk of surgical revision. Moreover, the reinsertion of a drain should only be used as a temporizing measure, at most, and patients requiring a drain to control the size of the seroma should promptly be scheduled for a surgical revision.

Background: Free tissue transfer is considered the gold standard in reconstruction of extensive defects in head and neck surgery. The aim of this 15-year retrospective study is to analyze the outcomes of free tissue transfers in the head and neck area in a tertiary referral university hospital. Materials and methods: A retrospective, single-center study of all patients undergoing free tissue transfers for head and neck reconstruction between 2006 and 2020 was performed. Patient demographics, comorbidities, flap characteristics, outcomes and complications were assessed. Results: A total of 353 free flaps were performed. The most common defect etiology was synchronous oncologic resection (74.2%). The majority of patients had at least one comorbidity (70.3%), with smoking recorded in 46.2% of the cases and alcohol consumption in 31.7%. The anterolateral thigh flap was the most commonly used flap (37.7%), followed by the osteoseptocutaneous fibula flap (26.9%). Our overall flap success rate was 97.7%, while the overall complication rate was 45.9%. Conclusions: Free tissue transfer in head and neck reconstruction is reliable. However, complication rates remain high due to the complexity of such cases and frequent presence of comorbidities. Nonetheless, when effectively managed within a multidisciplinary team, complications rarely jeopardize the overall reconstruction outcome.

Background: Necrotizing fasciitis (NF) is a rapidly progressing and life-threatening soft tissue infection. It commonly affects the extremities and is triggered by trauma, surgical wounds or compromised skin integrity. Although there have been advancements in diagnosis and treatment, NF continues to be a complex condition due to comorbidities and the wide range of involved pathogens. The aim of this study was to assess the epidemiology, risk factors, and outcomes of NF in Switzerland, focusing on the distinction between polymicrobial and monomicrobial infections and their associated management. Methods: This monocentric retrospective study analyzed 75 patients treated for intraoperatively confirmed NF from 2010 to 2022. Data collection included demographic and clinical variables, comorbidities, and laboratory results. Univariate and multivariate statistical tests were conducted to assess associations between mortality and different infection types. Results: NF was most commonly localized in the lower extremities (52% of cases). Nearly all patients (99%) had at least one comorbidity, with coronary heart disease, kidney disease, and liver disease being most frequently observed. Advanced age was associated with higher in-hospital mortality (OR (odds ratio) 3.80, p = 0.033, q = 0.500, 16 of 44 patients over 60 died), and the overall in-hospital mortality in the cohort was 27%. Kidney disease and smoking were associated with polymicrobial infections, with an OR of 6.60 (p = 0.016, q = 0.130) and 5.60 (p = 0.009, q = 0.130), respectively. Trauma was associated with monomicrobial streptococcal infections (OR 3.40, p = 0.029, q = 0.500), and showed a significant association with Streptococcus pyogenes infections (OR 8.10, p < 0.001, q = 0.004). Conclusions: This study highlights advanced age, trauma, kidney disease and smoking as factors associated with worse outcomes and specific infection patterns in patients with NF. These findings, derived from a Swiss patient population, underscore the importance of early identification of high-risk individuals to improve clinical outcomes. Recognizing these risk profiles may support clinicians in prioritizing rapid escalation of care for the patients most likely to benefit from early and aggressive intervention.