Diabetes mellitus in major head and neck cancer surgery: Systematic review and <scp>meta‐analysis</scp>

Caputo, Matthew; Shabani, Sepehr; Mhaskar, Rahul; McMullen, Caitlin; Padhya, Tapan; Mifsud, Matthew

doi:10.1002/hed.26349

Cited by 13 publications

(12 citation statements)

References 43 publications

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“…4,5 Patients requiring reconstructive surgery often suffer from diabetes mellitus or peripheral vascular disease, that were shown to increase the rate of flap failure up to 4.5-fold. [6][7][8][9] This may lead to tissue necrosis and jeopardizes the reconstructive result. Necrosis can subsequently cause a series of events resulting in inflammation and further loss of tissue integrity.…”

Section: Introductionmentioning

confidence: 99%

The secretome of stressed peripheral blood mononuclear cells increases tissue survival in a rodent epigastric flap model

Hacker

Mittermayr

Traxler

et al. 2020

Bioengineering & Transla Med

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Reconstructive surgery transfers viable tissue to cover defects and to restore aesthetic and functional properties. Failure rates after free flap surgery range from 3 to 7%. Comorbidities such as diabetes mellitus or peripheral vascular disease increase the risk of flap failure up to 4.5-fold. Experimental therapeutic concepts commonly use a monocausal approach by applying single growth factors. The secretome of γ-irradiated, stressed peripheral blood mononuclear cells (PBMCsec) resembles the physiological environment necessary for tissue regeneration. Its application led to improved wound healing rates and a twofold increase in blood vessel counts in previous animal models. We hypothesized that PBMCsec has beneficial effects on the survival of compromised flap tissue by reducing the necrosis rate and increasing angiogenesis. Surgery was performed on 39 male Sprague-Dawley rats (control, N = 13; fibrin sealant, N = 14; PBMCsec, N = 12). PBMCsec was produced according to good manufacturing practices (GMP) guidelines and 2 ml were administered intraoperatively at a concentration of 2.5 × 10 7 cells/ml using fibrin sealant as carrier substance. Flap perfusion and necrosis (as percentage of the total flap area) were analyzed using Laser Doppler Imaging and digital image planimetry on postoperative days 3 and 7. Immunohistochemical stainings for von Willebrand factor (vWF) and Vascular Endothelial Growth Factor-receptor-3 Wolfgang Michlits and Hendrik J. Ankersmit contributed equally.

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Section: Introductionmentioning

confidence: 99%

The secretome of stressed peripheral blood mononuclear cells increases tissue survival in a rodent epigastric flap model

Hacker

Mittermayr

Traxler

et al. 2020

Bioengineering & Transla Med

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“…Consisting of merely five studies, this analysis seemed relatively short of conclusiveness 38 . Further investigations were performed by Cupato et al 39 ; these authors www.nature.com/scientificreports/ www.nature.com/scientificreports/ www.nature.com/scientificreports/ www.nature.com/scientificreports/ gathered 16 studies for meta-analysis. They concluded that DM significantly increased flap failures and local region complications 39 .…”

Section: Discussionmentioning

confidence: 99%

“…Further investigations were performed by Cupato et al 39 ; these authors www.nature.com/scientificreports/ www.nature.com/scientificreports/ www.nature.com/scientificreports/ www.nature.com/scientificreports/ gathered 16 studies for meta-analysis. They concluded that DM significantly increased flap failures and local region complications 39 . This complication analysis was performed to include all major H&N surgeries instead of limiting the analysis to free-flap reconstructions 39 .…”

Section: Discussionmentioning

confidence: 99%

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Clinical consequences of head and neck free-flap reconstructions in the DM population

Chiu

Tsao

Chang

et al. 2021

Sci Rep

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Diabetes mellitus (DM) is a common comorbidity and risk factor for postoperative complications in head and neck (H&N) microsurgical reconstructions. Our study focused on the association between DM and individual complications regarding both surgical and medical aspects. A meta-analysis of English-language articles comparing a series of complications between DM and non-DM H&N free-flap recipients was performed by comprehensive meta-analysis (CMA). Twenty-seven articles presented 14,233 H&N free-flap reconstructions, and a subset of 2329 analyses including diabetic cases was included for final analysis. Total postoperative (RR = 1.194, p < 0.001; OR = 1.506, p = 0.030) and surgical (RR = 1.550, p = 0.001; OR = 3.362, p < 0.001) complications were increased in DM subjects. Free-flap failure/necrosis (RR = 1.577, p = 0.001; OR = 1.999, p = 0.001) and surgical site infections (OR = 2.414, p < 0.001) were also increased in diabetic recipients. However, return to the operating room, dehiscence, fistulas, plate exposures, readmissions, and mortalities were not increased in DM patients. DM increased various complications in H&N free-flap reconstructions. Surgical indications should be cautiously evaluated, and aggressive treatments should be implemented for high-risk recipients.

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“…Dear Editor, We greatly appreciate Caputo et al 1 efforts in conducting a systematic review and meta-analysis to determine whether diabetes mellitus (DM) is associated with increased rates of head and neck (H&N) cancer surgery complications or not. Their results proved that DM was associated with increased rates of flap failure and local complications.…”

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confidence: 99%