Free Tissue Transfers for Head and Neck Reconstruction in Patients with End-Stage Renal Disease on Dialysis: Analysis of Outcomes Using the Taiwan National Health Insurance Research Database

Oscar J. Manrique; Pedro Ciudad; Basel Sharaf; Jorys Martinez-Jorge; Steven Moran; Samir Mardini; Hung-Chi Chen; Uldis Bite; Hsu-Tang Cheng

doi:10.1055/s-0037-1603739

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2017; 33(08): 587-591
DOI: 10.1055/s-0037-1603739

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Free Tissue Transfers for Head and Neck Reconstruction in Patients with End-Stage Renal Disease on Dialysis: Analysis of Outcomes Using the Taiwan National Health Insurance Research Database

Authors

Oscar J. Manrique

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Pedro Ciudad

²Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan

³Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
Basel Sharaf

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Jorys Martinez-Jorge

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Steven Moran

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Samir Mardini

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Hung-Chi Chen

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Uldis Bite

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Hsu-Tang Cheng

²Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan

Abstract

Background Patients diagnosed with end-stage renal disease (ESRD) are increasing at around 5% annually. Some of these patients will require free tissue transfers to reconstruct their body after trauma or cancer resection. Comorbidities can increase the level of complexity during reconstruction.

Aim Our goal is to describe the outcomes of ESRD patients under dialysis who underwent free tissue transfer for head and neck reconstruction.

Methods Two cohorts were analyzed: ESRD group on dialysis and a non-ESRD control group after free tissue transfer for head and neck reconstruction. Postoperative complications and mortality were recorded. For coexisting comorbidities, we determine the presence of diabetes mellitus (DM) and peripheral vascular disease (PVD).

Results In this study, 85 cases with ESRD on dialysis and 841 controls were analyzed. Most patients were aged ≤ 65 years (82.5%) and nearly 92.9% of them were men. Types of head and neck cancer were neoplasm of other and unspecified parts of the mouth followed by neoplasm of tongue, the gingiva, hypopharynx, and floor of mouth. Patients with ESRD tended to have higher rates of DM and PVD (p < 0.001) and were significantly associated with an increased risk of stroke and increased risk of 30-day mortality. However, there was no significant difference regarding flap failure among groups.

Conclusion Despite greater preoperative risk factors, patients with renal failure on hemodialysis do not appear to have a higher rate of free flap failure following head and neck reconstruction. However, other complications can be minimized by optimizing patient's medical condition to succeed with this reconstructive effort.

Keywords

head and neck - dialysis - free tissue transfer

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Referenzen

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