Otolaryngology- Head and Neck Surgery最新文献

{"title":"Button Battery Ingestion: Exploring Socioeconomic Risk Factors.","authors":"J B Eyring, Brandon M Hemeyer, Stephen Walker, Wesley P Allen, Shi Liang, Christopher Stewart, Jeremy D Meier, Reema Padia","doi":"10.1002/ohn.1206","DOIUrl":"https://doi.org/10.1002/ohn.1206","url":null,"abstract":"<p><strong>Objective: </strong>Examine the demographic and social determinants of health linked to pediatric esophageal foreign body removals, with an emphasis on button battery ingestions.</p><p><strong>Study design: </strong>A retrospective chart review was performed on pediatric patients who underwent operative removal of a foreign body from the esophagus (Current Procedural Terminologies [CPTs] 43215, 43194).</p><p><strong>Setting: </strong>The study was conducted across four hospitals from November 2010 to December 2023.</p><p><strong>Methods: </strong>Data on patient demographics and social determinants of health were analyzed. Exclusions included nonaccidental ingestions, patients older than 18 years, and cases with missing social determinants of health data. The Agency for Healthcare Research and Quality (AHRQ) database was used to link patient data to socioeconomic indicators.</p><p><strong>Results: </strong>Of 825 cases, 50 were button battery ingestions. Age was comparable between button battery and nonbutton battery patients. Button battery patients were predominantly male. Socioeconomic analysis revealed that button battery patients were from households with higher median incomes, lower poverty rates, higher home values, and greater internet access. The incidence of button battery ingestion increased over the study period.</p><p><strong>Conclusion: </strong>This study highlights significant demographic and socioeconomic differences in pediatric foreign body ingestions compared to button battery ingestions. Male gender and higher socioeconomic status were notable risk factors for button battery ingestion. These findings support the need for educational and preventive strategies to address the risks associated with button battery ingestion.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Pediatric Acute Upper Airway Pathology During Local Wildfires and Increased PM 2.5 Burden.","authors":"Patrick Kiessling, Kara Meister, Douglas Sidell, Moira O'Bryan, Elizabeth Erickson-DiRenzo, Karthik Balakrishnan","doi":"10.1002/ohn.1191","DOIUrl":"https://doi.org/10.1002/ohn.1191","url":null,"abstract":"<p><strong>Objective: </strong>As wildfires worldwide increase in severity and frequency, fine particulate matter (PM 2.5), generated as a component of wildfire smoke, increasingly impacts air quality. Children are particularly vulnerable to poor air quality in numerous ways, including inhalation of more air in proportion to their body size than adults. Though its adverse impacts on the lower airway are well demonstrated, the clinical effects of PM 2.5 on the pediatric upper airway are poorly understood and warrant investigation.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary academic medical center.</p><p><strong>Methods: </strong>From 2014 to 2023, patient presentations to a pediatric emergency department in Northern California during exposure periods of elevated PM 2.5 burden associated with nearby wildfires were identified. Patient diagnoses, presenting symptoms, and management were analyzed. Comparison group patients were evaluated during date-matched control periods with confirmed normal air quality. Chi-squared analyses determined significance.</p><p><strong>Results: </strong>During periods of increased wildfire-generated PM 2.5 burden, a significantly greater proportion of pediatric patients presented to the emergency department with upper airway pathology compared to matched control periods of healthy air quality. Further, a significantly greater proportion of patients were diagnosed with croup during wildfires. Of patients presenting with upper airway pathology, a significantly greater proportion experienced dysphonia during wildfires and had a negative strep test.</p><p><strong>Conclusion: </strong>Wildfire-generated PM 2.5 may contribute to increased rates of croup presentations, and PM 2.5 may disproportionately affect the larynx in the pediatric upper airway. Larger population-based studies and preclinical models may clarify these clinical manifestations of a growing public health threat.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and Complications of 2-Stage Versus 3-Stage Paramedian Forehead Flaps.","authors":"W Jack Palmer, Dev Amin, Praneet Kaki, Matt Davis, Eric Fei, Neha Garg, Daniel J Campbell, Dana Michlin, Khashayar Arianpour, Howard Krein, Ryan Heffelfinger","doi":"10.1002/ohn.1210","DOIUrl":"https://doi.org/10.1002/ohn.1210","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore outcomes among 2-stage paramedian forehead flaps (PFFs), 3-stage PFFs, and PFFs undergoing accelerated pedicle takedown.</p><p><strong>Study design: </strong>A retrospective review.</p><p><strong>Setting: </strong>A tertiary care institution.</p><p><strong>Methods: </strong>Patients who underwent PFFs for nasal defects between 2017 and 2022 were identified. Demographic, clinical, and surgical characteristics were compared among groups. Surgical and cosmetic outcomes and revision procedures were evaluated.</p><p><strong>Results: </strong>Among 52 patients analyzed, 39 underwent 2-stage PFFs, and 13 underwent 3-stage PFFs. There were no significant differences in demographics, comorbidities, or surgical risk factors between groups. Three-stage PFF patients were more likely to have a cartilaginous defect. Postoperative dyspigmentation was seen more frequently in the 3-stage group; otherwise, there were no significant differences in outcomes. In a subanalysis of 29 patients requiring cartilage grafting, dyspigmentation was again seen more commonly in the 3-stage group; outcomes otherwise did not favor either group. Within the 2-stage group, 7 patients underwent accelerated pedicle takedown (≤21 days). No failures were seen with accelerated takedown, including among those who also received cartilage grafting. Overall, accelerated takedown was not associated with poorer surgical or cosmetic outcomes or an increased revision rate compared to standard takedown. Logistic regression did not identify any independent predictors of complication.</p><p><strong>Conclusion: </strong>Both 2- and 3-stage PFFs are effective tools in midface reconstruction, including when cartilage grafting is required. With 2-stage PFF, accelerated pedicle takedown is not associated with increased complications in appropriately selected patients.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing the Cellular Constituents of Proximal Airway Disease in Granulomatosis With Polyangiitis.","authors":"Wenda Ye, Evan Clark, Edward Talatala, Ruth Davis, Marisol Ramirez-Solano, Quanhu Sheng, Jing Yang, Sam Collins, Alexander Hillel, Alexander Gelbard","doi":"10.1002/ohn.1197","DOIUrl":"https://doi.org/10.1002/ohn.1197","url":null,"abstract":"<p><strong>Objective: </strong>Granulomatosis with polyangiitis (GPA) is a rare multisystem autoimmune vasculitis. 10-20% of patients suffer life-threatening obstruction of their proximal airways. Although progress has been made in the treatment of systemic disease, ameliorating airway disease in GPA remains an unmet need arising from limited understanding of disease pathogenesis. We sought to characterize the cellular constituents of the affected proximal airway mucosa in GPA airway scar.</p><p><strong>Study design: </strong>Basic/translational study.</p><p><strong>Setting: </strong>Single tertiary care center.</p><p><strong>Methods: </strong>Using single-cell RNA sequencing, we profiled the cellular constituents of proximal airway samples from GPA and disease comparators (GPA; n = 9, idiopathic subglottic stenosis: iSGS; n = 7, post-intubation proximal stenosis: PIPS; n = 5, and control; n = 10). We report transcriptomes for subglottic epithelial, immune, endothelial, and stromal cell types and map expression of GPA risk genes to tissue types present in the proximal airway. We compared differential gene expression across immune cell populations and performed pseudotime analysis using Monocle 3.</p><p><strong>Results: </strong>Similar to iSGS and PIPS, the subglottic mucosa of GPA patients demonstrated an abundant immune infiltrate. 71% of the established GPA risk genes (10 of 14) localized to T cells and macrophages. Differential gene expression and pseudotime analysis revealed a sub-population of CD4-/CD8- inflammatory T cells that only originated from GPA.</p><p><strong>Conclusion: </strong>We characterized the cellular composition of GPA airway disease and demonstrated that the expression of GPA risk alleles is predominantly localized to immune cell populations. We also identified a subset of inflammatory T cells that is unique to GPA.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Bilateral and Single-Sided Deaf Cochlear Implant Recipients in a Novel Speech-in-Noise and Localization Task.","authors":"Obada Abdulrazzak, Nadine I Ibrahim, Gerilyn Jones, Madison V Epperson, Ilhan Onder, Jackson Graves, Carolyn Kroger, Anahita H Mehta, Renee M Banakis Hartl","doi":"10.1002/ohn.1187","DOIUrl":"https://doi.org/10.1002/ohn.1187","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated how individuals who have undergone bilateral cochlear implantations (BiCIs) use compensatory head movements to optimize sound localization and speech-in-noise (SIN) performance compared with single-sided deaf users of cochlear implant (SSDCI) and normal hearing controls.</p><p><strong>Study design: </strong>Nonrandomized, prospective human-subject study.</p><p><strong>Setting: </strong>Tertiary academic medical center.</p><p><strong>Methods: </strong>Subjects were presented with Harvard IEEE sentences at varying signal-to-noise ratios (SNRs) in a darkened, semianechoic chamber. An electromagnetic head-tracking system monitored head movement. Outcomes included head movement patterns, localization accuracy, and SIN performance.</p><p><strong>Results: </strong>BiCI localized targets less accurately with higher SNR-dependent variability than controls, but with greater accuracy than SSDCI. For SIN, SSDCI consistently showed superior performance to the BiCI, with no statistical significance found at any noise condition between SSDCI and controls. Across SNR, BiCI consistently initiated head movements more promptly compared to SSDCI, with controls predictably exhibiting the least delay. All CI recipients exhibited greater absolute displacement overall compared to controls. Although BiCI showed greater displacement compared to SSDCI, their pattern resembled controls, with decreased movement necessary as SNR became more favorable.</p><p><strong>Conclusion: </strong>When comparing performance for localization and SIN across groups, the same impaired group does not perform most poorly at both binaural tasks; although SSDCI users maintain better speech understanding in noise, BiCIs tend to perform better on locating stimuli in space. Preserved acoustic hearing in one ear does not provide a performance advantage across all tasks. The study underscores the intricate interplay of adaptive behaviors in CI users, showcasing successes and challenges in optimizing binaural hearing performance.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trilayer Temporalis Fascia Interposition Graft for Nasal Septal Perforation Repair: A Continued Experience.","authors":"Derek J Vos, Kristen A Echanique, Amit Nag, Stephen Hadford, Peter Ciolek, Dane J Genther","doi":"10.1002/ohn.1183","DOIUrl":"https://doi.org/10.1002/ohn.1183","url":null,"abstract":"<p><strong>Objective: </strong>The repair of nasal septal perforation (NSP) is complex, with a variety of described techniques and reported outcomes. At our institution, we commonly perform NSP repair using a trilayer graft of thin polydioxanone (PDS) plate wrapped on both sides with temporalis fascia without intranasal flaps. We aim to report our continued experience with this technique.</p><p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Single institution.</p><p><strong>Methods: </strong>Retrospective chart review of patients undergoing repair of NSP using a trilayer temporalis fascial interposition grafting technique at our institution from 9/1/2018 to 10/31/2023.</p><p><strong>Results: </strong>Fifty-six patients (mean age 45 years, 58.9% female) were included in this study. The suspected cause of NSP was primarily iatrogenic (n = 26, 45.6%); however, a large number of patients did not have a definitive etiology of NSP (n = 18, 32.1%). The most commonly reported symptoms pre-operatively included nasal obstruction/congestion (n = 51, 91.1%) and nasal crusting (n = 31, 55.4%). NSPs were most frequently anterior in location (n = 46, 82.1%) and medium in size (1-2 cm) (n = 31, 55.4%), followed by small (<1 cm) (n = 17, 30.4%). All patients within this study experienced improvement in their pre-existing symptoms associated with NSP, with complete resolution of prior symptoms occurring in the majority of patients (n = 44, 78.6%). A minority of patients in this cohort experienced postoperative complications (n = 8, 14.3%). One patient (1.8%) demonstrated persistent perforation following repair. The median length of follow-up in this study was 257 days (range 65-1724).</p><p><strong>Conclusion: </strong>The trilayer temporalis fascial interposition graft is an effective and reliable tool for the repair of NSP.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Speech Changes in Velopharyngeal Function in Submucous Cleft Palate.","authors":"Soukaina Eljamri, Randall Harley, Matthew Ford, Noel Jabbour","doi":"10.1002/ohn.1218","DOIUrl":"https://doi.org/10.1002/ohn.1218","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate longitudinal speech changes in surgical and nonsurgical patients with submucous cleft palate (SMCP) and velopharyngeal dysfunction (VPD).</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single academic medical center.</p><p><strong>Methods: </strong>In total, 204 patients with documented SMCP and VPD from January 2002 to 2008 were identified. Using a multilevel mixed-effects model, we examined the association between surgical status and speech score trajectories, adjusting for age, sex, race, and severity.</p><p><strong>Results: </strong>In total, 204 children were included (mean [SD] age, 4.9 [3.1] years; 124 [60.8%] male; 114 [55.9%] furlow palatoplasty). Amongst surgical patients, the postsurgical median baseline score was 4 and scores were predicted to continue to decrease over time at a rate of 0.04 points per year (coefficient [β] -0.04, 95% confidence interval [95% CI] -0.20 to 0.13, P = .64). Presurgical speech scores were predicted to decrease over time at a rate of 0.78 points per year (β -0.78, 95% CI -1.14 to -0.41, P < .001). With a median presurgical score of 14, it would take 9 years to achieve normal speech scores without surgical intervention. In nonsurgical patients, speech scores were predicted to decrease at a rate of 0.23 points per year (β -0.23, 95% CI -0.51 to 0.04, P = .094).</p><p><strong>Conclusion: </strong>Speech production in VPD can improve over time without surgical intervention but is not expected to do so within the critical window for speech development. Surgical intervention improves speech by rates of change that cannot be achieved without surgery.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Insurance Coverage and Hearing Aid Utilization in U.S. Older Adults: National Health Interview Survey.","authors":"Diego E Razura, Nikko D Beady, Matthew E Lin, Janet S Choi","doi":"10.1002/ohn.1201","DOIUrl":"https://doi.org/10.1002/ohn.1201","url":null,"abstract":"<p><strong>Objective: </strong>Assess rates of hearing aid use by insurance coverage in U.S. older adults and their changes over time.</p><p><strong>Study design: </strong>Cross-sectional analysis of the National Health Interview Survey 2007-2018.</p><p><strong>Setting: </strong>Participants (≥65 years) with complete data on insurance, hearing aid use, and self-reported hearing limitations.</p><p><strong>Methods: </strong>Rates of hearing aid use among older adults who self-reported hearing limitations and their trends were estimated using survey weights. Sixteen insurance categories were created based on exclusive and combinatorial coverage, with Medicare coverage only as a reference group. The associations between insurance coverage and hearing aid use were examined using multivariable regression analyses.</p><p><strong>Results: </strong>Hearing aid use rate among older adults who self-reported hearing limitations was 51.2% in the United States. In multivariable models adjusting for demographics, socioeconomic status, self-reported hearing loss, and comorbidities, Military insurance only and Military & Medicare groups reported higher hearing aid use rates than Medicare only (odds ratio [OR] 3.14, 95% confidence interval [CI] 1.49-6.64; OR 1.8, 95% CI 1.55-2.09, respectively). During 2007-2018, there were no significant changes in hearing aid use rates by insurance groups among private, Medicaid, and military insurance coverage.</p><p><strong>Conclusion: </strong>While hearing aid use remains low among U.S. older adults, Military-related insurance, which generally provides enhanced coverage for hearing aids, was independently associated with higher use rates compared to Medicare, which does not offer coverage. Future research should examine the direct impact of different insurance policies on hearing aid use and its downstream health benefits.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Stepwise Technology-Based Audiometry With Rapid Results (STARR) Protocol in Minnesota Elementary Schools.","authors":"Autefeh Sajjadi, Morgan McBride, Kimberly Guettler, Stephanie Janasko, Staci House, Cesley Bergsten, Nobles Antwi, Madeline Marker, Soorya Todatry, Stacey Rabusch, Rebecca Maher, Brianne Roby, Abby C Meyer, Andrew Redmann, Sivakumar Chinnadurai, Asitha D L Jayawardena","doi":"10.1002/ohn.1192","DOIUrl":"https://doi.org/10.1002/ohn.1192","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to understand the utility of a stepwise technology-based audiometry with rapid results (STARR) school screening protocol.</p><p><strong>Study design: </strong>A prospective cohort study.</p><p><strong>Setting: </strong>Six elementary schools in a single school district in Minnesota.</p><p><strong>Methods: </strong>Students at 6 elementary schools in Minnesota participated in the STARR protocol and underwent initial technology-based hearing screening, followed by additional comprehensive automated audiometry with insert earphones and point-of-care otoscopy if they were referred. Results were reviewed by an otolaryngologist remotely, and parents received treatment recommendations based on these findings.</p><p><strong>Results: </strong>A total of 454 (81% of eligible) students were screened and 27 students (5.9%) referred. On average, the initial screening took 55 seconds (standard deviation [SD] = 22) for those who passed and 116 seconds (SD = 55) for those who were referred. Comprehensive audiometry screening took 163 seconds (SD = 27) for those who passed and 252 seconds (SD = 100) for those who referred. A team of 6 screeners could screen a class of 30 students in 30 minutes. The total number of nursing encounters required to ensure a student saw a provider after a referral was reduced using the STARR protocol (2.47 encounters per referral) compared to traditional audiometric screening (3.39 encounters per referral) (P < .01).</p><p><strong>Conclusion: </strong>The STARR protocol is a feasible and efficient method of screening in public schools that can reduce false referral rate, provide parents with more information at the point of referral, and reduce nursing burden.</p><p><strong>Implications for practice: </strong>Technology-based hearing screenings should be considered in school settings as a means to provide more patient and family-centered hearing health care. Further research is necessary to understand how the STARR protocol influences loss to follow-up rates after failed hearing screening.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late Flap Failure: Etiology and Management.","authors":"Matthew B Studer, Skylar H Trott, Sara Yang, Farshid Taghizadeh, Mark K Wax","doi":"10.1002/ohn.1193","DOIUrl":"https://doi.org/10.1002/ohn.1193","url":null,"abstract":"<p><strong>Objective: </strong>Late free flap failure is an unusual setback for patients; we investigated the etiology and management of late flap failure.</p><p><strong>Study design: </strong>Single-institution retrospective review of 1959 free flaps from 2010 to 2023 for head and neck defects.</p><p><strong>Setting: </strong>Tertiary Academic Medical Center.</p><p><strong>Methods: </strong>Late failure was defined as initial detection of vascular compromise on postoperative day 6+, who went on to have total or partial flap loss. Variables included age, subsite, medical history, complications, day of detection, failure etiology, and treatment. Late failure cohort was compared to a cohort of 499 patients with long-term flap survival and 37 patients with early flap failure. Oregon Health and Science University (OHSU) Institutional Review Board (IRB) approval obtained; study number IRB00003898.</p><p><strong>Results: </strong>Thirty-one patients had late failure (1.6%). Twenty-five (80.6%) had total flap failure; six (19.4%) had partial failure. The majority (17, 54.8%) were associated with a postoperative complication (infection, fistula, wound dehiscence, or hematoma) which contributed to flap compromise. Average time until detection was 11 days. Patients had two or more reoperations in 21 cases (67.7%); rotational flaps were most common (19, 61.3%) followed by a second free flap (9, 29%). In comparing the late failure and long-term flap survival cohorts, late failure patients had a higher proportion of having had at least one intraoperative pedicle revision (41.9% vs 15.4%, odds ratio [OR] = 3.96 [95% confidence interval (CI) 1.86-8.41]); early flap failure patients had similar pedicle revision rates to late failure patients. Late failure patients had more postoperative infections than early failure patients (41.9% vs 18.9%, OR = 3.10 [95% CI 1.04-9.20]).</p><p><strong>Conclusion: </strong>Patients with late free flap failure require multiple operations for debridement and secondary reconstruction. Patients with both late and early failure are more likely to have had intraoperative pedicle revision. Postoperative infection is more common in late flap failure than early flap failure.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}