Free Tissue Transfers for Head and Neck Reconstruction in Patients with End-Stage Renal Disease on Dialysis: Analysis of Outcomes Using the Taiwan National Health Insurance Research Database

Abstract

Background Patients diagnosed with end-stage renal disease (ESRD) are increasing at around 5% annually. Some of these patients will require free tissue transfers to reconstruct their body after trauma or cancer resection. Comorbidities can increase the level of complexity during reconstruction. Aim Our goal is to describe the outcomes of ESRD patients under dialysis who underwent free tissue transfer for head and neck reconstruction. Methods Two cohorts were analyzed: ESRD group on dialysis and a non-ESRD control group after free tissue transfer for head and neck reconstruction. Postoperative complications and mortality were recorded. For coexisting comorbidities, we determine the presence of diabetes mellitus (DM) and peripheral vascular disease (PVD). Results In this study, 85 cases with ESRD on dialysis and 841 controls were analyzed. Most patients were aged ≤ 65 years (82.5%) and nearly 92.9% of them were men. Types of head and neck cancer were neoplasm of other and unspecified parts of the mouth followed by neoplasm of tongue, the gingiva, hypopharynx, and floor of mouth. Patients with ESRD tended to have higher rates of DM and PVD (p < 0.001) and were significantly associated with an increased risk of stroke and increased risk of 30-day mortality. However, there was no significant difference regarding flap failure among groups. Conclusion Despite greater preoperative risk factors, patients with renal failure on hemodialysis do not appear to have a higher rate of free flap failure following head and neck reconstruction. However, other complications can be minimized by optimizing patient's medical condition to succeed with this reconstructive effort.

Oral and maxillofacial surgery in patients undergoing dialysis for advanced renal disease: report of five cases

“…Patients are typically scheduled to be dialyzed the day before surgery and re-started the day after surgery, for control of fluids, minerals, and electrolyte metabolism [ 4 ]. During the intraoperative period, anesthesiologists and oral surgeons should consider the possibility of hypovolemia and profound hypotension induced by intraoperative blood loss and general anesthesia [ 5 ].…”

“…In general, arteriosclerosis or vascular calcification often causes thrombosis after vascular anastomosis [ 19 ]. Thus, such risks of vascular anastomosis in hemodialysis patients should be considered [ 2 , 5 ]. As far as we detected, there is one latest study of vascular reconstruction and free flap transfer in Gangrenous lesions of the foot or lower leg due to severe diabetic arterial disease [ 20 ].…”

“…Surgery and management of dialysis patients carries a high risk of complications, higher mortality rate, and require careful perioperative management [ 2 – 5 ].…”

“…There are some recent clinical studies about the head and neck surgeries in hemodialysis patients [ 2 , 3 , 5 ]. They suggested the mortality rate and circulatory or respiratory complications are high in these patients.…”

Total Maxillectomy and Free Flap Reconstruction in Hemodialysis Patients: Report of Two Cases

“…However, little has been reported on head and neck reconstruction in patients undergoing HD. [2][3][4] The major concern is the possibility of reconstructive failure owing to the associated vascular disease or poor healing ability of the patients undergoing HD. There is also concern regarding perioperative HD management, including anticoagulation and HD scheduling.…”