Professor, Oral & Maxillofacial Surgery (MWU), Program Director, Division of Oral & Maxillofacial Surgery, Adjunct Attending Physician, Division of Otolaryngology, Cook County Health, Chicago, IL.
Research Fellow, Division of Oral and Maxillofacial Surgery, Cook County Health, Chicago, IL.
J Oral Maxillofac Surg. 2023 Nov;81(11):1435-1442. doi: 10.1016/j.joms.2023.08.006. Epub 2023 Aug 16.
Jehovah's Witnesses (JW) population are members of a religious group that refuses blood transfusion. This presents a dilemma for surgical teams when performing major surgical procedures on these patients.
This study aimed to assess the safety and feasibility of undergoing microvascular free flaps for maxillofacial reconstruction in JW patients and whether the type of underlying pathology impacts outcomes.
STUDY DESIGN, SETTING, AND SAMPLE: This was a multi-institutional retrospective cohort study. The sample consisted of all JW patients who have undergone microvascular free tissue transfer for maxillofacial pathology between January 2016 and January 2021.
The primary predictor variable was the underlying pathology for which patients underwent head and neck free flap reconstruction; this was benign versus malignant disease.
The primary outcome variables were safety, defined as discharge from the hospital with no mortality, and feasibility defined as successful free flap reconstruction.
Other variables included age, race, sex, length of surgery, length of hospital stay, and intraoperative use of vasopressors.
Data analysis was performed utilizing t-tests for means and χ for proportions. Alpha was set at < 0.05.
A total of 12 participants from 7 participating sites met the inclusion criteria. There were 9 males and 3 females with a mean age of 58.3 ± 8.3 years. There were no deaths in this cohort and all patients were discharged from the hospital. All 12 free flap reconstructions were successful with no incidents of free flap loss; none of the patients received any blood transfusions or any other blood products. Subgroup analysis showed that patients treated for malignant disease versus benign disease had longer operations (11.2 ± 2.9 vs 6.3 ± 0.2 hours, P < .01) and a longer hospital length of stay (11.8 ± 4.9 vs 5.3 ± 0.5 days, P = .04).
Our series supports the safety and feasibility of maxillofacial free flap reconstruction in this challenging subset of patients. Microvascular reconstructive surgeries for malignant diseases often result in longer operative times and hospital stays.
耶和华见证会（JW）教徒是拒绝输血的宗教团体成员。这给手术团队在为这些患者进行重大手术时带来了困境。
本研究旨在评估 JW 患者接受颌面显微血管游离皮瓣重建的安全性和可行性，以及潜在的病理类型是否会影响结果。
研究设计、地点和样本：这是一项多机构回顾性队列研究。样本包括 2016 年 1 月至 2021 年 1 月期间接受颌面显微血管游离组织转移治疗头颈部病变的所有 JW 患者。
主要预测变量是患者行头颈部游离皮瓣重建的基础病理；良性与恶性疾病。
主要结局变量是安全性，定义为无死亡出院，可行性定义为游离皮瓣重建成功。
其他变量包括年龄、种族、性别、手术时间、住院时间和术中使用血管加压素。
数据采用 t 检验进行均值分析，χ 2 检验进行比例分析。α 值设定为 <0.05。
共有来自 7 个参与地点的 12 名参与者符合纳入标准。9 名男性和 3 名女性，平均年龄 58.3±8.3 岁。本队列无死亡病例，所有患者均出院。12 例游离皮瓣重建均成功，无一例游离皮瓣丢失；无患者接受输血或任何其他血液制品。亚组分析显示，治疗恶性疾病与良性疾病的患者手术时间更长（11.2±2.9 小时比 6.3±0.2 小时，P<.01），住院时间更长（11.8±4.9 天比 5.3±0.5 天，P=.04）。
我们的系列研究支持在这一具有挑战性的患者亚群中进行颌面游离皮瓣重建的安全性和可行性。恶性疾病的显微血管重建手术通常导致手术时间和住院时间延长。
