Perioperative risk factors that predict complications of radial forearm free flaps in oral and maxillofacial reconstruction

Wang, C.; Fu, Ganglan; Liu, F.; Liu, L.; Cao, Minghui

doi:10.1016/j.bjoms.2018.04.015

Cited by 21 publications

(19 citation statements)

References 16 publications

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“…Other indications are trauma, infection, osteoradionecrosis, congenital defects, dysmorphism, and preprosthetic surgery. [1][2][3][4] Thirty-two percent of the patients undergoing head and neck reconstructive surgery face surgical complications. 5 Smoking tobacco is one of the major risk factors in the development of 68% of head and neck cancers.…”

Section: Introductionmentioning

confidence: 99%

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

Garip¹,

Dessel

Grosjean

et al. 2021

British Journal of Oral and Maxillofacial Surgery

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Reconstructive surgery with a free vascularised tissue flap is indicated in large defects in the head and neck region, which arise mostly because of head and neck cancer. Tobacco smoking is a major risk factor for head and neck cancer, and many patients undergoing reconstructive surgery in the head and neck have a history of smoking. The objective of this meta-analysis was to determine the impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap. A systematic review was undertaken for articles reporting and comparing the incidence of overall surgical complications after reconstructive surgery with a free vascularised tissue flap between smokers and nonsmokers. Relevant articles were searched using PubMed, Cochrane, and Embase databases, and screened for eligibility according to the PRISMA guidelines. The risk of bias analysis was conducted using the Newcastle-Ottawa quality assessment scale. A meta-analysis was performed to quantitatively compare the incidence rate of overall surgical complications, flap failure, surgical site infection, fistula, and haematoma between smokers and nonsmokers using OpenMetaAnalyst (open source) software. Only qualitative analysis was performed for wound dehiscence, bleeding, nerve injury, and impaired wound healing. Forty-six articles were screened for eligibility; 30 full texts were reviewed, and 19 studies were included in the quantitative meta-analysis. From the 19 studies, 18 were retrospective and 1 was a prospective study. In total, 2155 smokers and 3124 nonsmokers were included in the meta-analysis. Smoking was associated with a significantly increased risk of 19.12% for haematoma (95% Confidence Interval (CI): 4.75-33.49; p < 0.01), and of 4.57% for overall surgical complications (95% CI: 1.97-7.15; p < 0.01). No significant difference in risk was found for flap failure (95% CI: −4.33-9.90; p = 0.44), surgical site infection (95% CI: −0.88-2.60; p = 0.33) and fistula formation (95% CI: −3.81-3.71; p = 0.98) between smokers and nonsmokers. Only for flap failure was a significant heterogeneity found (I 2 = 63.02%; p = 0.03). Smoking tobacco was significantly associated with an increased risk of overall surgical complications and haematoma, but did not seem to affect other postoperative complications. Encouraging smoking cessation in patients who need reconstructive head and neck surgery remains important, but delaying surgery to create a non-smoking interval is not needed to prevent the investigated complications. More high-quality retrospective or prospective studies with a standardised protocol are needed to allow for definitive conclusions.

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Section: Introductionmentioning

confidence: 99%

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

Garip¹,

Dessel

Grosjean

et al. 2021

British Journal of Oral and Maxillofacial Surgery

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“…Shum et al ( 6 studied patients who underwent reconstruction with microsurgical flaps of the head and neck and observed that those either malnourished or with low prealbumin levels had a higher incidence of total flap loss. A study by Wang et al ( 21 ) observed that, in radial free forearm flaps, low postoperative concentration of albumin was a risk factor for complications. In our study, hypoalbuminemia in preoperative or post-operative periods was not associated with higher incidence of complications Clavien-Dindo grade III or total flap loss, being the first study of microsurgical flaps for traumatic limb reconstruction not related with oncologic resection and flap reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Hypoalbuminemia in Microsurgical Flaps of the Musculoskeletal Apparatus

Silva

Cho

et al. 2020

Acta ortop. bras.

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Objective: To evaluate if the levels of serum total protein and serum albumin are risk factors for surgical complications of free flap limb reconstruction. Methods: Consecutive inclusion of all patients undergoing microsurgical flaps for limb reconstruction of complex injuries. We recorded epidemiological and laboratory data, including total proteins and fractions, for descriptive and analytical statistics. Results: Our study analyzed one microsurgical flap from 35 patients that underwent complex injuries of the limbs. In total, 23 patients were men, and mean age of all patients was 35 years. After statistical analysis, no influence of pre or postoperative hypoalbuminemia was observed on the incidence of complications. Patients with hypoalbuminemia had a higher length of stay than those with normal albumin levels (p = 0.008). Conclusion: We observed that 71% of patients had hypoalbuminemia in early postoperative period and we suggest a nutritional support for patients requiring complex traumatic limb reconstruction. Hypoalbuminemia in patients subjected to microsurgical flaps for the treatment of complex traumatic limb injuries did not influence the complications that required surgical reintervention; However, it was associated with prolonged hospital stay. Level of Evidence II, Retrospective study.

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“…Travmaya bağlı büyük doku defektleri ve/veya tümör ameliyatlarında yapılan kapsamlı rezeksiyonlar şekil ve işlev bozukluğuna yol açabilir. Dolayısıyla bu hastalarda hem defekt bölgesinin fonksiyonunun tamamen veya kısmen geri kazanılması hem de hastanın yaşam kalitesinin arttırılması amacıyla flep rekonstrüksiyonu yaygın olarak uygulanmaktadır (1,2). Özellikle distal alt ekstremite defektlerinin rekonstrüksiyonunda serbest doku flebi ilk tercihtir.…”

Section: Introductionunclassified

“…Postoperatif flep komplikasyon oranına; ileri yaş, American Society of Anesthesiologist (ASA) skoru ve perioperatif aşırı sıvı kullanımı gibi pek çok faktörün etki edebileceği belirtilmektedir (1,6,7).…”

Section: Introductionunclassified

“…Çünkü anestezi, hem perioperatif hemodinamik kontrol sağlayarak hem de serbest flebin vasküler perfüzyonunu geliştirerek mikrovasküler flep başarısına etki etmektedir (2). Serbest flep komplikasyonuna etki eden perioperatif risk faktörlerinin değerlendirildiği bir çalışmada, Visual Analog skala (VAS) skorları ve perioperatif sıvı yönetimi de dahil olmak üzere özellikle anestezi ile ilişkili perioperatif risk faktörlerinin düzenlenmesinin postoperatif flep komplikasyonunun azaltılmasında önemli olduğu vurgulanmaktadır (1).…”

Section: Introductionunclassified

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Predicting Factors Affecting Post-operative Flap Complications in Patients Undergoing Flap Reconstruction Due to Tissue Defect in Lower Extremity

Karaveli¹,

Uslu²

2021

tybd

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arasında alt ekstremitede doku defekti nedeni ile flep rekonstrüksiyonu uygulanan ve yoğun bakım ünitesinde (YBÜ) takip edilen hastalarda postoperatif serbest doku flep komplikasyonlarını etkileyen faktörleri değerlendirilmesidir. Gereç ve Yöntem: Hastaların demografik verileri, doku defektinin boyutu, hemoglobin düzeyi, anestezi ve cerrahi süreleri, kan transfüzyon miktarları, postoperatif komplikasyon varlığı, hastanede yatış süreleri, doku kültür sonuçları ve YBÜ'de yatış süreleri retrospektif olarak kayıt altına alındı. İstatistiksel analiz SPSS'de yapıldı. Bulgular: Doku defektinin en sık nedeni trafik kazasıydı ve defekt boyutu 118,35±74,74 cm 2 idi. Postoperatif komplikasyonun 12 (%42,9) hastada geliştiği gözlemlendi. En sık gelişen komplikasyonlar; hematom ve parsiyel flep nekrozuydu. On hastanın (%35,7) kültür sonuçlarında üreme olduğu saptandı. Flep komplikasyonu gelişen hastalarda, gelişmeyenlerle karşılaştırıldığında, sigara kullanımı, Amerikan Anestezistler Derneği skoru ve yaş anlamlı olarak daha yüksekti (p<0,05). YBÜ'de yatış süreleri benzerdi. Postoperatif hastanede yatış süreleri bu hastalarda daha uzundu (p<0,05). Sonuç: Çalışmamızda, postoperatif flep komplikasyon gelişimi açısından sigara kullanımı, yaş ve ASA skorunun önemli birer risk faktörü olduğu görüldü. Bu hastalarda postoperatif hastanede yatış süresinin daha uzun olduğu belirlendi.

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Perioperative risk factors that predict complications of radial forearm free flaps in oral and maxillofacial reconstruction

Cited by 21 publications

References 16 publications

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

Hypoalbuminemia in Microsurgical Flaps of the Musculoskeletal Apparatus

Predicting Factors Affecting Post-operative Flap Complications in Patients Undergoing Flap Reconstruction Due to Tissue Defect in Lower Extremity

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