Diabetes as Main Risk Factor in Head and Neck Reconstructive Surgery With Free Flaps

Abstract

The aim of our study was to demonstrate the role of certain risk factors in reconstructive head and neck surgery with free flaps. The data taken from the charts of all patients who received free flap for head and neck reconstruction in our department between January 2001 and December 2004 were analyzed. We evaluated the association of preexisting risk factors with the onset of surgical complications such as orocutaneous fistulae, flap infections, hematomas, thrombosis, and necrosis. One hundred and twenty-two free flaps have been used for the reconstruction of head and neck area in 118 patients. Preoperative risk factors included smoking habit (77 patients), alcohol use (6 patients), hypertension (9 patients), diabetes mellitus (8 patients), family history positive for vascular disorders (27 patients), and hypercholesterolemia/hypertriglyceridemia (5 patients). The percentage of full flap survival was 95.08%. Statistical analysis showed that diabetes mellitus (P < 0.01) is significantly associated with a negative prognosis for free flap reconstructive operation, whereas a smoking habit seemed to be at the verge of statistical significance. Therefore, our current practice is to prefer as much as possible the use of local flaps as opposed to free flaps in the reconstruction of head and neck defects in diabetic patients.

Prevention of thrombosis after microvascular tissue transfer in the head and neck. A review of the literature and the state of affairs in Dutch Head and Neck Cancer Centers

“…The influence of smoking on thrombosis during or after microvascular reconstructive procedures with free-flaps in the head and neck has not been studied extensively, although its contribution to general complications is well known 6,14,17,20,36,38 . Smoking plays a part in the incidence of delayed wound healing in general, but is not a proven risk factor for head and neck free-flap failure in specific (Table 4) 6,14,17,20,36,38 .…”

“…These conditions, such as diabetes mellitus, advanced atherosclerosis or other cardiovascular diseases influence the incidence of complications and are likely to impair the quality of the vessel wall and wound healing in general 5,27,36,38 . Factors such as old age and the presence of tumour are considered to be risk factors for venous thrombolytic events 19 .…”

Botulinum toxin type A on cutaneous flap viability in diabetic and tobacco-exposed rats

“…In fact, diabetes causes endothelial dysfunction, increased oxidative stress, and decreased epidermal cell migration, which hinders the wound healing process 2,3 . Tobacco exposure causes vasoconstriction, increasing the risk of flap necrosis 4 .…”

Outcomes comparison of head and neck free tissue transfers in three different hospital populations

“…Other reports have demonstrated that medical complications; such as diabetes, 15,16 pulmonary problems, 9 or alcohol-induced mental disorder 9,17 may play a role in negatively affecting flap outcomes.…”