Radiotherapy and Smoking History Are Significant Independent Predictors for Osteosynthesis-Associated Late Complications in Vascular Free Fibula Reconstruction of Mandible

Chen, Yiming; Wu, Jialing; Gokavarapu, Sandhya; Shen, Qiang; Ji, Tong

doi:10.1097/scs.0000000000003704

Cited by 21 publications

(21 citation statements)

References 20 publications

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“…From the 16 articles included in the systematic review, 8 studies demonstrated a significant increase in smokers 1,7,[17][18][19][20]22,24 and 8 studies showed no significant difference in overall surgical complications between smokers and nonsmokers. [2][3][4]9,10,14,29,32 Eleven articles were included in the quantitative meta-analysis to investigate the effect of smoking on overall surgical complications (Fig.…”

Section: Overall Surgical Complicationsmentioning

confidence: 99%

“…[2][3][4]14,16 Several studies demonstrated an increased risk for surgical complications, including flap failure, haematoma, wound dehiscence, and impaired wound healing in smokers after head and neck reconstructive surgery. 1,[5][6][7][17][18][19][20][21][22][23][24] The objective of the present systematic review and meta-analysis was to determine the impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap. More specifically, how smoking affects overall surgical complications, flap failure, surgical site infection, fistula formation, wound dehiscence, haematoma, bleeding, nerve damage, and impaired wound healing.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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: Overall Surgical Complicationsmentioning

confidence: 99%

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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“…Chen y cols. 7 ya concluyeron en su estudio que el tabaco y la radioterapia eran predictores independientes de complicaciones tardías en pacientes reconstruidos con colgajos peroneos microvascularizados 7 . Es conocido que las complicaciones asociadas a estos pacientes en numerosos casos pueden deberse a las comorbilidades de los mismos y a su patología primaria, siendo más frecuente las complicaciones en pacientes con patología maligna que patología benigna, por lo que no se puede descartar que exista un sesgo de selección.…”

Section: Discussionunclassified

Radioterapia en colgajos peroneos. Revisión de la densidad ósea y complicaciones en colgajos peroneos irradiados frente a no irradiados

Domingo¹,

Segura-Illa²,

Nieto³

et al. 2019

j.maxilo

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“…13 % berichtet. Plattenbrüche traten dabei zwar bei Miniplattenosteosynthesen deutlich häufiger auf (10 vs. 0 %) [17,19], die Problematik liegt demnach aber vorwiegend im ersatzschwachen Lager und in adjuvanten Therapien (Radiatio, Radiochemotherapie) begründet. Auch hängt die Rate an Pseudarthrosen signifikant vom verwendeten Transplantattyp ab.…”

Section: Mikrovaskuläre Rekonstruktionenunclassified

“…B. freiliegenden Platten, assoziiert. Diese Komplikation tritt gehäuft nach prä-und/ oder postoperativer Bestrahlung auf [19] (vgl. ▶ Abb.…”

Section: Merke Die Prävention Einer Pseudarthrose Durch Stabile Osteounclassified

Pseudarthrosen im Mund-Kiefer-Gesichts-Bereich

Neff¹,

Jung²

2019

OP-JOURNAL

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ZusammenfassungAuch wenn sie in Standardsituationen heute selten sind, stellen Pseudarthrosen eine relevante Komplikation dar. Insbesondere nach aufwendigen Kieferrekonstruktionen mittels z. B. Fibula- und Beckenkammtransplantaten sind Komplikationen mit hohen Belastungen für die betroffenen Patienten und die erbringende chirurgische Disziplin verbunden. Dieser Beitrag zeigt, wo und warum Pseudarthrosen in der MKG-Chirurgie heute eine Rolle spielen und welche Therapieoptionen bestehen.

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Radiotherapy and Smoking History Are Significant Independent Predictors for Osteosynthesis-Associated Late Complications in Vascular Free Fibula Reconstruction of Mandible

Abstract: Postoperative radiation and smoking history are associated with late complications. Mini Ti plate should be less used. Patients with risk factors need to be observed for at least 6 to 16 months before further management.

Cited by 21 publications

References 20 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

Radioterapia en colgajos peroneos. Revisión de la densidad ósea y complicaciones en colgajos peroneos irradiados frente a no irradiados

Pseudarthrosen im Mund-Kiefer-Gesichts-Bereich

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