Skoner Judith M, Wax Mark K
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Head Neck. 2008 Apr;30(4):455-60. doi: 10.1002/hed.20720.
Jehovah's Witnesses' religious convictions disallow blood transfusion. Major surgery in these patients is therefore problematic. The objective of this study is to describe our experience with microvascular reconstruction of complex head and neck defects in Jehovah's Witness patients.
This was a retrospective review of all Jehovah's Witnesses' patients undergoing head and neck free-flap reconstruction at a tertiary academic referral center from 1997 to 2006.
Five Jehovah's Witnesses patients underwent a total of 7 free-flap reconstructions (6 radial, 1 rectus). Four flaps were immediate: 1 osteocutaneous radial forearm, 2 fasciocutaneous radial forearm, and 1 rectus abdominus myocutaneous. One fasciocutaneous radial forearm flap was staged. Two patients were planned secondary reconstructions, both facsciocutaneous radial forearm. Iron supplements and/or erythropoietin were administered perioperatively in 6 of the 7 microvascular reconstructions. Selective external carotid embolization was performed preoperatively in 1 patient. Hematocrit levels were 36% to 46% preoperatively and 30% to 41% postoperatively. Immediate postoperative hematocrit decline was 5.2% (3.0% to 6.0%). No transfusions or blood products were administered.
Our case series supports the feasibility of head and neck free-flap reconstruction in these challenging patients.
耶和华见证人的宗教信仰禁止输血。因此，这些患者进行大手术存在问题。本研究的目的是描述我们在耶和华见证会患者中进行复杂头颈部缺损微血管重建的经验。
这是一项对1997年至2006年在一家三级学术转诊中心接受头颈部游离皮瓣重建的所有耶和华见证会患者的回顾性研究。
5名耶和华见证会患者共接受了7次游离皮瓣重建手术（6次桡侧皮瓣，1次腹直肌皮瓣）。4次皮瓣移植为即时移植：1次桡骨前臂骨皮瓣、2次桡骨前臂筋膜皮瓣和1次腹直肌肌皮瓣。1次桡骨前臂筋膜皮瓣为分期移植。2名患者计划进行二次重建，均为桡骨前臂筋膜皮瓣。7例微血管重建中有6例在围手术期给予了铁补充剂和/或促红细胞生成素。1例患者术前进行了选择性颈外动脉栓塞。术前血细胞比容水平为36%至46%，术后为30%至41%。术后即时血细胞比容下降5.2%（3.0%至6.0%）。未输注血液或血液制品。
我们的病例系列支持在这些具有挑战性的患者中进行头颈部游离皮瓣重建的可行性。
