术前和术中管理对放射性骨坏死需游离皮瓣重建患者结局的影响。

Impact of preoperative and intraoperative management on outcomes in osteoradionecrosis requiring free flap reconstruction.

机构信息

Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Science Center New Orleans, New Orleans, Louisiana, USA.

Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

出版信息

Head Neck. 2022 Mar;44(3):698-709. doi: 10.1002/hed.26957. Epub 2021 Dec 17.

DOI:10.1002/hed.26957

PMID:34918862

Abstract

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.

摘要

背景

需要游离皮瓣（FF）重建的头颈部晚期放射性骨坏死的围手术期管理方式多种多样。我们的目标包括评估实践模式和结果。

方法

对头颈放射性骨坏死（n=260）行 FF 重建的多机构回顾性研究。

结果

术前使用抗生素与减少术后并发症无关。术前饮酒与更高的硬件暴露（p=0.03）和 30 天再入院率（p=0.04）相关。FF 功能受损的患者 TSH（p=0.04）更高，白蛋白水平更低（p=0.005）。需要颈冲洗（p=0.02）或第二个 FF（p=0.03）的患者前白蛋白水平更低。TSH 水平在接受术后清创（p=0.03）或局部皮瓣手术的患者中更高（p=0.04）。