Influence of diabetes mellitus on postoperative complications and failure in head and neck free flap reconstruction: A systematic review and meta-analysis

Head & Neck ◽  
2014 ◽  
Vol 37 (4) ◽  
pp. 615-618 ◽  
Author(s):  
Pablo Rosado ◽  
Hsu-Tang Cheng ◽  
Chao-Min Wu ◽  
Fu-Chan Wei
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Postoperative Complications ◽  
Head And Neck ◽  
Free Flap ◽  
Meta Analysis ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

Enhanced recovery after surgery for head and neck free flap reconstruction: A systematic review and meta-analysis

Oral Oncology ◽  
2021 ◽  
Vol 113 ◽  
pp. 105117
Author(s):  
Kevin Chorath ◽  
Beatrice Go ◽  
Justin R. Shinn ◽  
Leila J. Mady ◽  
Seerat Poonia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Free Flap ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Meta Analysis ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

Influence of preoperative radiotherapy on head and neck free‐flap reconstruction: Systematic review and meta‐analysis

Head & Neck ◽  
2020 ◽  
Vol 42 (8) ◽  
pp. 2165-2180 ◽  
Author(s):  
Ainiwaer Mijiti ◽  
Nazuke Kuerbantayi ◽  
Zhi Q. Zhang ◽  
Ming Y. Su ◽  
Xiao H. Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Free Flap ◽  
Preoperative Radiotherapy ◽  
Meta Analysis ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery

2018 ◽  
Vol 159 (5) ◽  
pp. 817-823 ◽  
Author(s):  
Meghan M. Crippen ◽  
Jacob S. Brady ◽  
Alexander M. Mozeika ◽  
Jean Anderson Eloy ◽  
Soly Baredes ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Postoperative Complications ◽  
Head And Neck ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Increased Risk

Objective Analyze the risk for perioperative complications associated with body mass index (BMI) class in patients undergoing head and neck free flap reconstruction. Study Design and Setting Retrospective cohort study. Subjects and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of head and neck free flaps between 2005 and 2014 (N = 2187). This population was stratified into underweight, normal-weight, overweight, and obese BMI cohorts. Groups were compared for demographics, comorbidities, and procedure-related variables. Rates of postoperative complications were compared between groups using χ2 and binary logistic regression analyses. Results Underweight patients (n = 160) had significantly higher rates of numerous comorbidities, including disseminated cancer, preoperative chemotherapy, and anemia, while obese patients (n = 447) had higher rates of diabetes and hypertension. Rates of overall surgical complications, medical complications, and flap loss were insignificantly different between BMI groups. Following regression, obese BMI was protective for perioperative transfusion requirement (odds ratio [OR] = 0.63, P = .001), while underweight status conferred increased risk (OR = 2.43, P < .001). Recent weight loss was found to be an independent predictor of perioperative cardiac arrest (OR = 3.16, P = .006) while underweight BMI was not (OR = 1.21, P = .763). However, both weight loss and underweight status were associated with significantly increased risk for 30-day mortality (OR = 4.48, P = .032; OR = 4.02, P = .010, respectively). Conclusion Obesity does not increase the risk for postoperative complications in head and neck free flap surgery and may be protective in some cases. When assessing a patient’s fitness for surgery, underweight status or recent weight loss may suggest a reduced ability to tolerate extensive free flap reconstruction.

scholarly journals Naso- or Orbitocutaneous Fistulas after Free Flap Reconstruction of Orbital Exenteration Defects: Retrospective Study, Systematic Review, and Meta-Analysis

2017 ◽  
Vol 78 (04) ◽  
pp. 337-345 ◽  
Author(s):  
Kurren Gill ◽  
David Hsu ◽  
Gurston Nyquist ◽  
Howard Krein ◽  
Jurij Bilyk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Free Flap ◽  
Meta Analysis ◽  
Fistula Formation ◽  
Wound Complications ◽  
Orbital Exenteration ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Orbital Wall

Objective Naso- or orbitocutaneous fistula (NOF) is a challenging complication of orbital exenteration, and it often requires surgical repair. We sought to identify the incidence and risk factors for NOF after orbital exenteration. Study Design Retrospective chart review, systematic review, meta-analysis. Setting Tertiary care center. Participants Patients undergoing free flap reconstruction following orbital exenteration. Records were reviewed for clinicopathologic data, operative details, and outcomes. Main Outcome Measures Univariate analysis was used to assess risk factors for incidence of postoperative NOF. PubMed and Cochrane databases were searched for published reports on NOF after orbital exenteration. Rates of fistula and odds ratios for predictive factors were compared in a meta-analysis. Results Total 7 of 77 patients (9.1%) developed NOF; fistula formation was associated with ethmoid sinus involvement (p < 0.05) and minor wound break down (p < 0.05). On meta-analysis, pooled rates of fistula formation were 5.8% for free flap patients and 12.5% for patients receiving no reconstruction. Conclusion Immediate postoperative wound complications and medial orbital wall resection increased the risk for NOF. On review and meta-analysis, reconstruction of orbital exenteration defects decreased the risk for fistula formation, but published series did not demonstrate a significant decrease in risk with free flaps compared with other methods of reconstruction.

Postoperative anticoagulation after free flap reconstruction for head and neck cancer: A systematic review

2017 ◽  
Vol 128 (2) ◽  
pp. 412-421 ◽  
Author(s):  
Blair M. Barton ◽  
Charles A. Riley ◽  
John C. Fitzpatrick ◽  
Christian P. Hasney ◽  
Brian A. Moore ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

Impact of Sarcopenia on Outcomes of Autologous Head and Neck Free Tissue Reconstruction

2020 ◽  
Vol 36 (05) ◽  
pp. 369-378
Author(s):  
Alexander J. Jones ◽  
Mohamedkazim M. Alwani ◽  
Leah J. Novinger ◽  
Eric Pittelkow ◽  
Andrea Bonetto ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Postoperative Complications ◽  
Head And Neck ◽  
Free Flap ◽  
Lumbar Vertebra ◽  
Postoperative Outcomes ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Skeletal Muscle Index ◽  
Tissue Reconstruction

Abstract Background Sarcopenia has been implicated as a positive predictor of postsurgical complications. Its role in head and neck (H&N) free flap reconstruction has yet to be examined. Our study aimed to determine the clinical impact of sarcopenia on postoperative outcomes in patients receiving autologous free tissue reconstruction for H&N cancer (HNC). Methods A retrospective case–control study was conducted at our tertiary referral center. Patients with HNC who received oncologic resection followed by autologous free tissue reconstruction were included. Preoperative abdominal computed tomography (CT) imaging was analyzed at the third lumbar vertebra (L3) to calculate skeletal muscle cross-sectional area (CSA, cm2). Skeletal muscle index (SMI, cm2/m2) was calculated by normalizing CSA to patient height. Sarcopenia at L3 was defined as SMI ≤ 41.6 cm2/m2 for males and ≤ 32.0 cm2/m2 for females. Data analyses were performed to compare postoperative outcomes. Results Of the 168 patients who met inclusion criteria, 47 patients (28.0%) were determined to have preoperative sarcopenia. The sarcopenic group was older (63 vs. 58 years, p = 0.017), had lower body mass index (BMI; 21.2 vs. 27.2, p < 0.001), had greater incidence of alcohol abuse (55.3 vs. 23.1%, OR = 4.11, p < 0.001). Intraoperatively, sarcopenic patients were found to have greater rates of blood transfusions (63.8 vs. 29.8%, p < 0.001). Postoperatively, sarcopenic patients had higher rates of pneumonia (p < 0.01), venous thromboembolism (p < 0.01), prolonged ventilation (p < 0.01), delirium (p < 0.01), fistula (p < 0.05), wound disruption (p < 0.05), and longer intensive care unit stays (p < 0.05). Sarcopenic patients were ultimately found to have higher overall rates of general postoperative complications (p < 0.001) and flap-specific complications (p < 0.01). Conclusion Sarcopenia was found to be a predictor of postoperative complications in H&N free flap reconstruction, signifying its value as a negative prognostic factor in surgical outcomes. This study reflects level of evidence IV.

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