Closure of craniofacial defects after cancer resection

Wornom, Isaac L.; Neifeld, James P.; Mehrhof, Austin I.; Young, Harold F.; Chinchilli, Vernon M.

doi:10.1016/0002-9610(91)90160-f

Cited by 27 publications

(17 citation statements)

References 12 publications

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“…Complications also increased after CFR for advanced lesions in a series of 57 malignant cutaneous tumors invading the anterior cranial fossa, previously reported by the senior author. 21 Wornom et al 22 found that the presence of large, combined defects involving both frontal and temporal areas was the single most important risk factor for the development of postoperative complications. Irish and colleagues 13 also found a much higher rate of complications after skull base resections that encompass more than one skull base site.…”

Section: Discussionmentioning

confidence: 99%

Complications of anterior craniofacial resection

et al. 1999

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Background The complications associated with anterior craniofacial resections for benign and malignant tumors were reviewed in 104 patients treated between January 1981 and June 1996. Methods Information regarding patient characteristics, histologic type, history of prior therapy, extent of the disease, extent of surgical procedure, and type of reconstruction were entered in a microcomputer database. To better understand and stage postoperative complications, we divided them into early (<14 days) and late (>14 days) according to the time of presentation, into major and minor depending on the morbidity potential of complication, and into local and systemic ones. Comparison between risk factors associated with complications was made using chi‐square analysis with Yates' correction for continuity. Survival analysis was performed using the Kaplan‐Meier product limit method. Results There were 8 (7.6%) postoperative deaths, with only 1 occurring from systemic complications. Complications occurred in 53 (48.6%) patients. Local major complications occurred in 49 (45%) patients, local minor in 29 (26.6%), and systemic in 11 (10%). Early complications occurred in 40 (38.5%) patients and late complications in 13 (12.5%) patients. These complications developed during a period ranging from 1 day to 5 months. More than one complication occurred in a number of patients. Bacterial contamination leading to local septic complications was the principal cause of morbidity, accounting for 54.7% (29/53) of complications. Major complications included meningitis in 8 patients associated with cerebrospinal fluid leak in 7, cerebral abscess in 2, sepsis in 1, and subdural hemorrhage in 1, all of which resulted in death except for one case. The extent of the craniofacial resection (p = .011) was the most important factor associated with major complications. Invasion of the dura and the type of reconstruction of the anterior skull base were the most important factors related to cerebrospinal fluid leakage (p = .048 and p = .032) and meningitis (p= .011). Conclusion Contemporary surgical approaches and methods of reconstruction have enabled skull base surgeons to extend their cranial base resections and increase the 5‐year survival rates of patients. Nevertheless, significant complications persist. Knowledge and high index of suspicion together with early recognition of these complications are essential for effective management of patients undergoing craniofacial resection. The factors related to major complications found in this study stressed the need to develop more effective methods to prevent contamination of intracranial structures. © 1999 John Wiley & Sons, Inc. Head Neck 21: 12–20, 1999.

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Section: Discussionmentioning

confidence: 99%

Complications of anterior craniofacial resection

et al. 1999

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“…This is in contrast to studies that primarily used a surgical approach to cover skull wounds. 9 Their results showed that after cancer resection, primary closure of anterior or temporal craniofacial defects is associated with a 16–22% complication rate. 9 Large combined defects have an even higher rate of wound complication.…”

Section: Discussionmentioning

confidence: 99%

“… 9 Their results showed that after cancer resection, primary closure of anterior or temporal craniofacial defects is associated with a 16–22% complication rate. 9 Large combined defects have an even higher rate of wound complication. All in all, our method produces few complications and excellent cosmetic results comparable to those from secondary intention reports.…”

Section: Discussionmentioning

confidence: 99%

Granulation Tissue Flap Technique in Extensive Wounds for Covering Exposed Bone After Tumor Excision

Winter

Haas

2000

Dermatologic Surgery

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“…This placed severe limits on the amount of anterior fossa dura that could be resected. Wornom et al 9 found a very high complication rate when local or skin grafts were used to reconstruct large composite defects.…”

Section: Ketcham Et Almentioning

confidence: 99%

“…5,7À9,14,18,20,23À30 When clearly specified, the rate of prior surgery in many reports is also quite high, with reports ranging from 52% to 78%. 5,9,18,20,23,24,26,28,29 In a number of reports, FTT was used preferentially to reconstruct massive defects after surgery for recurrent disease. 5,7,20,23,28 The univariate analysis demonstrated a strong association between surgery for recurrent disease and major wound complications for all patients, as well as for the subgroup of patients who were reconstructed with an LF (Tables 3 and 5).…”

Section: à820à24mentioning

confidence: 99%