Impact of preoperative and intraoperative management on outcomes in osteoradionecrosis requiring free flap reconstruction
Impact of preoperative and intraoperative management on outcomes in osteoradionecrosis requiring free flap reconstruction
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DOI：
10.1002/hed.26957
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发表时间：
2021-12-17
影响因子：
2.9
通讯作者：
Sweeny, Larissa
中科院分区：
文献类型：
--
作者：
Mayland, Erica;Curry, Joseph M.;Sweeny, Larissa
背景：需要游离皮瓣重建的晚期头颈部放射性骨坏死的围手术期处理各有不同。我们的目标包括评估实践模式和结果。方法对260例头颈部放射性骨坏死患者行FF重建的多机构回顾性研究。结果术前应用抗生素与术后并发症的减少无关。术前饮酒与较高的硬件暴露(p=0.03)和30天再住院(p=0.04)相关。FF妥协的患者有较高的促甲状腺激素水平(p=0.04)和较低的白蛋白水平(p=0.005)。前白蛋白水平在需要颈部冲洗(p=0.02)或第二次颈部冲洗(p=0.03)的患者中较低。TSH水平在术后清创(p=0.03)或局部皮瓣手术(p=0.04)患者中较高。结论营养不良、甲状腺功能减退和药物滥用与晚期放射性骨坏死接受FF重建的患者术后伤口并发症的发生率较高相关。术前使用抗生素与术后伤口并发症的减少无关。
Background Perioperative management of advanced osteoradionecrosis of the head and neck requiring free flap (FF) reconstruction varies. Our objectives included assessment of practice patterns and outcomes. Methods Multi-institutional, retrospective review of FF reconstruction for head and neck osteoradionecrosis (n = 260). Results Administration of preoperative antibiotics did not correlate with reduction in postoperative complications. Preoperative alcohol use correlated with higher rates of hardware exposure (p = 0.03) and 30-day readmission (p = 0.04). Patients with FF compromise had higher TSH (p = 0.04) and lower albumin levels (p = 0.005). Prealbumin levels were lower in patients who required neck washouts (p = 0.02) or a second FF (p = 0.03). TSH levels were higher in patients undergoing postoperative debridement (p = 0.03) or local flap procedures (p = 0.04). Conclusion Malnutrition, hypothyroidism, and substance abuse correlated with a higher incidence of postoperative wound complications in patients undergoing FF reconstruction for advanced osteoradionecrosis. Preoperative antibiotics use did not correlate with a reduction in postoperative wound complications.