Microsurgical reconstruction for head and neck in patients with end-stage renal disease undergoing dialysis

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2024-05-08 DOI:10.1002/micr.31186

Chen-Ting Hung MD, Meng-Si Wu MD, Chien-Hsing Wang MD, Li-Fu Cheng MD, Yu-Fu Chou MD, Chia-Fone Lee MD, Peir-Rong Chen MD, Jiunn-Tat Lee MD

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引用次数: 0

Abstract

Introduction

Free flap transfer for head and neck defects has gained worldwide acceptance. Because flap failure is a devastating outcome, studies have attempted to identify risk factors—including renal failure. We sought to determine whether end-stage renal disease (ESRD) patients undergoing dialysis are at increased risk of flap failure following microsurgical head and neck reconstruction.

Patients and Methods

The study's participants were patients who underwent free flap reconstruction in the head and neck region at Hualien Tzu Chi Hospital between January 2010 and December 2019. We used the National Health Insurance “Specific Diagnosis and Treatment Code” to identify patients undergoing dialysis; these patients comprised the dialysis group, whose members were matched to a non-dialysis group for age and gender. The dependent variables were flap survival rate, take-back rate, and flap failure risk between the dialysis and non-dialysis groups.

Results

We included 154 patients in the dialysis (n = 14) and non-dialysis (n = 140) groups. The groups were similar in terms of age and most comorbidities, except diabetes mellitus, hypertension, and coronary artery disease, which were more prevalent in the dialysis group. The dialysis and non-dialysis groups had similar flap survival rates (100% vs. 92.9%; p = .600). Twenty-three patients underwent take-back surgery, most in the non-dialysis group (14.3% vs. 15.0%; p = 1.000). Patients in the dialysis group were more likely to have prolonged intensive care unit stays; however, dialysis alone did not predict flap failure (OR: 0.83; p = .864).

Conclusion

This study found no significant differences in free flap survival and take-back rates between patients with and without dialysis. Dialysis did not increase the risk of flap failure following microsurgical head and neck reconstruction in this study; however, prospective, randomized controlled trials are needed.

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透析终末期肾病患者头颈部的显微外科重建。

简介游离皮瓣转移治疗头颈部缺损已被全世界所接受。由于皮瓣失败是一种破坏性结果，因此研究人员试图找出包括肾功能衰竭在内的风险因素。我们试图确定接受透析的终末期肾病（ESRD）患者在头颈部显微外科重建术后皮瓣失败的风险是否会增加：研究对象为2010年1月至2019年12月期间在花莲慈济医院接受头颈部游离皮瓣重建术的患者。我们使用国民健康保险的 "特定诊断和治疗代码 "来识别接受透析的患者；这些患者组成透析组，其成员在年龄和性别上与非透析组相匹配。因变量为透析组和非透析组之间的皮瓣存活率、收回率和皮瓣失败风险：透析组（14 人）和非透析组（140 人）共有 154 名患者。除糖尿病、高血压和冠状动脉疾病在透析组较常见外，两组患者的年龄和大多数合并症相似。透析组和非透析组的皮瓣存活率相似（100% vs. 92.9%; p = .600）。23名患者接受了回取手术，其中大部分是非透析组患者（14.3% 对 15.0%；P = 1.000）。透析组患者更有可能延长重症监护室的住院时间；但透析本身并不能预测皮瓣失败（OR：0.83；P = .864）：本研究发现，透析和非透析患者的游离皮瓣存活率和收回率没有明显差异。透析不会增加头颈部显微外科重建术后皮瓣失败的风险，但还需要进行前瞻性随机对照试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.