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.
Head Neck. 2022 Mar;44(3):698-709. doi: 10.1002/hed.26957. Epub 2021 Dec 17.
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.
Multi-institutional, retrospective review of FF reconstruction for head and neck osteoradionecrosis (n = 260).
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).
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.
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。
对头颈放射性骨坏死（n=260）行 FF 重建的多机构回顾性研究。
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）。
营养不良、甲状腺功能减退和物质滥用与接受游离皮瓣重建的晚期放射性骨坏死患者术后伤口并发症的发生率较高相关。术前使用抗生素与减少术后伤口并发症无关。
