Surgical and remote site infections after reconstructive surgery of the head and neck: A risk factor analysis

Schuderer, Johannes; Spörl, Steffen; Spanier, Gerrit; Gottsauner, Maximilian; Gessner, André; Hitzenbichler, Florian; Meier, Johannes; Reichert, Torsten E.; Ettl, Tobias

doi:10.1016/j.jcms.2021.11.002

Cited by 5 publications

(4 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Subsequently, the connection of microvascular grafts via the temporal or facial vascular axis becomes necessary. However, flap success in the pre-irradiated area poses a significant challenge [ 24 ]. Shonka and colleagues conducted a study involving 62 microvascular scalp reconstructions, revealing that 89% of the reported complications occurred specifically within the pre-irradiated tissue region [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Flap Loss: Analysis of Donor and Recipient Vessel Morphology in Patients Undergoing Microvascular Head and Neck Reconstructions

Schuderer

Dinh

Spoerl

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

In microvascular head and neck reconstruction, various factors such as diabetes, alcohol consumption, and preoperative radiation hold a risk for flap loss. The primary objective of this study was to examine the vessel morphology of both recipient and donor vessels and to identify predictors for changes in the diameters of H.E.-stained specimens associated with flap loss in a prospective setting. Artery and vein samples (N = 191) were collected from patients (N = 100), with sampling from the recipient vessels in the neck area and the donor vessels prior to anastomosis. External vessel diameter transverse (ED), inner vessel diameter transverse (ID), thickness vessel intima (TI), thickness vessel media (TM), thickness vessel wall (TVW), and intima-media ratio (IMR) for the recipient (R) and transplant site (T) in arteries (A) and veins (V) were evaluated using H.E. staining. Flap loss (3%) was associated with increased ARED (<italic>p</italic> = 0.004) and ARID (<italic>p</italic> = 0.004). Preoperative radiotherapy led to a significant reduction in the outer diameter of the recipient vein in the neck (<italic>p</italic> = 0.018). Alcohol consumption (<italic>p</italic> = 0.05), previous thrombosis (<italic>p</italic> = 0.007), and diabetes (<italic>p</italic> = 0.002) were associated with an increase in the total thickness of venous recipient veins in the neck. Diabetes was also found to be associated with dilation of the venous media in the neck vessels (<italic>p</italic> = 0.007). The presence of cardiovascular disease (CVD) was associated with reduced intimal thickness (<italic>p</italic> = 0.016) and increased total venous vessel wall thickness (<italic>p</italic> = 0.017) at the transplant site. Revision surgeries were linked to increased internal and external diameters of the graft artery (<italic>p</italic> = 0.04 and <italic>p</italic> = 0.003, respectively), while patients with flap loss showed significantly increased artery diameters (<italic>p</italic> = 0.004). At the transplant site, alcohol influenced the enlargement of arm artery diameters (<italic>p</italic> = 0.03) and the intima–media ratio in the radial forearm flap (<italic>p</italic> = 0.013). In the anterolateral thigh, CVD significantly increased the intimal thickness and the intima–media ratio of the graft artery (<italic>p</italic> = 0.01 and <italic>p</italic> = 0.02, respectively). Patients with myocardial infarction displayed increased thickness in the <italic>A. thyroidea</italic> and artery media (<italic>p</italic> = 0.003). Facial arteries exhibited larger total vessel diameters in patients with CVD (<italic>p</italic> = 0.03), while facial arteries in patients with previous thrombosis had larger diameters and thicker media (<italic>p</italic> = 0.01). The presence of diabetes was associated with a reduced intima–media ratio (<italic>p</italic> < 0.001). Although the presence of diabetes, irradiation, and cardiovascular disease causes changes in vessel thickness in connecting vessels, these alterations did not adversely affect the overall success of the flap.

show abstract

Section: Discussionmentioning

confidence: 99%

Risk Factors for Flap Loss: Analysis of Donor and Recipient Vessel Morphology in Patients Undergoing Microvascular Head and Neck Reconstructions

Schuderer

Dinh

Spoerl

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…We searched the database and retrieved a total of 32 studies for meta‐analysis 7,9,10,12,15–42 . The literature screening process is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Incidence and risk factors of surgical site infection in patients with head and neck cancer: A meta‐analysis

Wang,

Hou

et al. 2023

Head & Neck

View full text Add to dashboard Cite

We systematically review the incidence and risk factors of surgical site infection (SSI) in patients with head and neck cancer. PubMed, Embase, Cochrane Library, and Web of Science databases were searched to obtain studies on the risk factors for SSI in patients with HNC. The retrieval time was from the establishment of the database to February 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in included studies. Meta‐analysis was performed by using Stata 15.1 software. A total of 32 articles including 128 919 patients with head and neck cancer and 2949 cases of SSI were included in this meta‐analysis. The incidence rate of SSI in head and neck cancer ranges from 19% to 29%, and the overall infection rate was 24%. Meta‐analysis indicated that BMI < 20 kg/m2 (OR, 2.64; 95% CI, 1.74–4.00; I2, 0%), diabetes (OR, 3.00; 95% CI, 2.12–4.16; I2, 60.6%), ASA score (OR, 1.51; 95% CI, 1.29–1.77; I2, 0%), radiotherapy (OR, 2.27; 95% CI, 1.87–2.77; I2, 44.8%), chemotherapy (OR, 2.36; 95% CI, 1.64–3.40; I2, 0%), clindamycin antibiotic (OR, 2.99; 95% CI, 1.82–2.93; I2, 36.5%), deficit repair (OR, 3.76; 95% CI, 1.22–11.59; I2, 91.4%), neck dissection (OR, 2.13; 95% CI, 1.63–2.79; I2, 16.4%), blood transfusion (OR, 2.29; 95% CI, 1.52–3.45; I2, 66.2%), mandibular (OR, 3.17; 95% CI, 1.85–5.42; I2, 73%), tracheostomy (OR, 2.51; 95% CI, 1.74–3.62; I2, 86.4%), operation time (OR, 1.42; 95% CI, 1.16–1.74; I2, 86.4%), ALB (OR, 2.48; 95% CI, 1.95–3.15; I2, 5.3%) were risk factors of surgical site infection in patients with head and neck cancer (p < 0.05). The results of the sensitivity analysis showed good agreement in all risk factors and the results had stability. The present meta‐analysis suggests that BMI < 20 kg/m2, diabetes, ASA score, radiotherapy, chemotherapy, clindamycin antibiotic, deficit repair, neck dissection, blood transfusion, mandibular, tracheostomy, operation time, and ALB were significant risk factors for SSI.

show abstract

“…We found that previous radiation exposure in the head and neck area was an independent predictor for elective tracheotomy in our study group. Radiation above 60 Gray resulted in clinically manifested fibrosis, which, in turn, may significantly impair bone nutrition and result in infections, pathological fractures and various other postoperative complications [22,23]. Restricted neck movement, trismus and muscle-relaxant-resistant altered pharynx physiology can complicate laryngoscopy (both direct and via video observation), thus resulting in a difficult airway [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…With an incidence of up to 50%, HAP is ranked as the most common complication following major head and neck surgeries [28]. The most prominent risk factors for HAP after head neck surgery are a postoperative ventilation duration greater than 48 h and the time spent on the intensive care unit [22]. Postoperatively, the loss of protective reflexes can promote aspiration of saliva and thus lead to the development of HAP unattached to tracheotomy status [29].…”

Section: Discussionmentioning

confidence: 99%

Elective Tracheotomy in Patients Receiving Mandibular Reconstructions: Reduced Postoperative Ventilation Time and Lower Incidence of Hospital-Acquired Pneumonia

Schuderer

Reider

Wunschel

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

Elective tracheotomy (ET) secures the airway and prevents adverse airway-related events as unplanned secondary tracheotomy (UT), prolonged ventilation (PPV) or nosocomial infection. The primary objective of this study was to identify factors predisposing for airway complications after reconstructive lower ja surgery. We reviewed records of patients undergoing mandibulectomy and microvascular bone reconstruction (n = 123). Epidemiological factors, modus of tracheotomy regarding ET and UT, postoperative ventilation time and occurrence of hospital-acquired pneumonia HAP were recorded. Predictors for PPV and HAP, ET and UT were identified. A total of 82 (66.7%) patients underwent tracheotomy of which 12 (14.6%) were performed as UT. A total of 52 (42.3%) patients presented PPV, while 19 (15.4%) developed HAP. Increased operation time (OR 1.004, p = 0.005) and a difficult airway (OR 2.869, p = 0.02) were predictors, while ET reduced incidence of PPV (OR 0.054, p = 0.006). A difficult airway (OR 4.711, p = 0.03) and postoperative delirium (OR 6.761, p = 0.01) increased UT performance. HAP increased with anesthesia induction time (OR 1.268, p = 0.001) and length in ICU (OR 1.039, p = 0.009) while decreasing in ET group (HR 0.32, p = 0.02). OR for ET increased with mounting CCI (OR 1.462, p = 0.002) and preoperative radiotherapy (OR 2.8, p = 0.018). ET should be strongly considered in patients with increased CCI, preoperative radiotherapy and prolonged operation time. ET shortened postoperative ventilation time and reduced HAP.

show abstract

Surgical and remote site infections after reconstructive surgery of the head and neck: A risk factor analysis

Cited by 5 publications

References 67 publications

Risk Factors for Flap Loss: Analysis of Donor and Recipient Vessel Morphology in Patients Undergoing Microvascular Head and Neck Reconstructions

Risk Factors for Flap Loss: Analysis of Donor and Recipient Vessel Morphology in Patients Undergoing Microvascular Head and Neck Reconstructions

Incidence and risk factors of surgical site infection in patients with head and neck cancer: A meta‐analysis

Elective Tracheotomy in Patients Receiving Mandibular Reconstructions: Reduced Postoperative Ventilation Time and Lower Incidence of Hospital-Acquired Pneumonia

Contact Info

Product

Resources

About