Division of Facial Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, Missouri.
Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California.
JAMA Facial Plast Surg. 2019 Jul 1;21(4):298-304. doi: 10.1001/jamafacial.2018.1855.
Paramedian forehead flaps are commonly used to reconstruct facial defects caused by skin cancers. Data are lacking on the complications from this procedure, postoperative outcomes, and association of cancer diagnosis with rate of deep venous thrombosis (DVT).
The primary objective was to determine complication rates after paramedian forehead flap reconstruction for defects resulting from resection of facial cancers; and the secondary objective was to determine patient factors and complications that are associated with readmission.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of patients who underwent paramedian forehead flap reconstruction for skin cancer reconstruction from January 1, 2007, through December 31, 2013. Data analysis took place between October 1, 2017, and June 1, 2018.
Complication rates including DVT, emergency department visits, and hospital readmissions.
A total of 2175 patient were included in this study; mean (SD) age, 70.3 (13.4) years; 1153 (53.5%) were men. Postoperative DVT occurred in 10 or fewer patients (≤0.5%); postoperative bleeding in 30 (1.4%), and postoperative infection in 63 (2.9%). Most patients went home on the day of surgery (89.6%; n = 1949), while 10.4% stayed one or more days in the hospital (n = 226). Overnight admission was associated with tobacco use (odds ratio [OR], 1.65; 95% CI, 1.11-2.44), hypothyroidism (OR, 1.93; 95% CI, 1.10-3.39), hypertension (OR, 1.82; 95% CI, 1.29-2.57), ear cartilage graft (OR, 2.20; 95% CI, 1.51-3.21), and adjacent tissue transfer (OR, 1.88; 95% CI, 1.33-2.67). Risk factors strongly associated with immediate return to the emergency department or readmission within 48 hours of surgery included postoperative bleeding (OR, 13.05; 95% CI, 4.24-40.16), neurologic disorder (OR, 4.11; 95% CI, 1.12-15.09), and alcohol use (OR, 7.70; 95% CI, 1.55-38.21).
In this study, the most common complication of paramedian forehead flap reconstruction was infection. Risk factors for readmission included development of postoperative bleeding, having a neurologic disorder, and alcohol use. Deep venous thrombosis was a rare complication. Because bleeding is a more common complication in this patient population, discretion should be used when deciding to administer anticoagulation medication to low- to medium-risk patients prior to surgery.
NA.
额正中皮瓣常用于重建因皮肤癌导致的面部缺陷。关于该手术的并发症、术后结果以及癌症诊断与深静脉血栓形成（DVT）发生率的关系，数据尚缺乏。
主要目的是确定因面部癌症切除而进行额正中皮瓣重建后的并发症发生率；次要目的是确定与再入院相关的患者因素和并发症。
设计、设置和参与者：这是一项对 2007 年 1 月 1 日至 2013 年 12 月 31 日期间接受额正中皮瓣修复皮肤癌重建的患者进行的回顾性队列研究。数据分析于 2017 年 10 月 1 日至 2018 年 6 月 1 日进行。
并发症发生率，包括 DVT、急诊就诊和医院再入院。
本研究共纳入 2175 例患者；平均（SD）年龄为 70.3（13.4）岁；1153 例（53.5%）为男性。术后 DVT 发生在 10 例以下（≤0.5%）；术后出血 30 例（1.4%），术后感染 63 例（2.9%）。大多数患者在手术当天出院（89.6%；n=1949），10.4%的患者住院 1 天以上（n=226）。住院过夜与吸烟（比值比[OR]，1.65；95%CI，1.11-2.44）、甲状腺功能减退（OR，1.93；95%CI，1.10-3.39）、高血压（OR，1.82；95%CI，1.29-2.57）、耳软骨移植物（OR，2.20；95%CI，1.51-3.21）和相邻组织转移（OR，1.88；95%CI，1.33-2.67）相关。与术后立即返回急诊室或术后 48 小时内再入院密切相关的危险因素包括术后出血（OR，13.05；95%CI，4.24-40.16）、神经障碍（OR，4.11；95%CI，1.12-15.09）和酒精使用（OR，7.70；95%CI，1.55-38.21）。
在这项研究中，额正中皮瓣重建最常见的并发症是感染。再入院的危险因素包括术后出血、神经障碍和酒精使用。深静脉血栓形成是一种罕见的并发症。由于在该患者人群中出血是一种更常见的并发症，因此在手术前决定对低至中危患者使用抗凝药物时应慎重。
无。
