Microvascular head and neck reconstruction in patients with liver cirrhosis
Journal
Head and Neck
Journal Volume
30
Journal Issue
7
Pages
829-835
Date Issued
2008
Author(s)
Abstract
Background. The aim of this retrospective case series was to review the safety, complications, and outcomes of free-tissue transfer in head and neck cancer reconstruction in patients with liver cirrhosis. Methods. A retrospective review of all microvascular head and neck reconstruction cases with concomitant liver cirrhosis treated in our institution from 1994 to 2005 was performed. Data collected included patient demographics, etiology, and severity of liver cirrhosis, defect site, choice of free flap, complications, and clinical follow-up. Results. Seven patients were identified. They were all males and underwent microvascular head and neck reconstruction due to ablative cancer surgery. Their Child-Pugh classification of liver cirrhosis was graded as follows: Child A (n = 3); Child B (n = 3); and Child C (n = 1). Eight free flaps were transferred (1 patient received 2), including anterolateral thigh (n = 4); radial forearm (n = 3); and fibula (n = 1). All flaps survived without the need for any microvascular revision procedures. Two patients died within postoperative 30 days due to hepatic decompensation. Other complications included neck hematoma (n = 1), neck wound infection (n = 2), and donor site dehiscence (n = 1). Only 2 patients with Child A cirrhosis remained free from complications and survived more than 1 year after the surgery. Conclusion. Microvascular head and neck reconstruction may be performed in patients with liver cirrhosis with a certain degree of technical success. However, the procedure is associated with significant mortality and morbidity in Child class B and C patients. Therefore, we recommend avoiding free-tissue transfer in patients with head and neck cancer with advanced liver cirrhosis. ?2008 Wiley Periodicals, Inc.
SDGs
Other Subjects
adult; aged; alcohol consumption; article; bleeding; cancer recurrence; clinical article; clinical evaluation; comorbidity; coronary artery disease; death; decompensated liver cirrhosis; demography; diabetes mellitus; disease severity; free tissue graft; head and neck cancer; head and neck surgery; Hepatitis B virus; human; hypertension; liver cirrhosis; liver tumor; male; microvascular surgery; patient information; priority journal; survival rate; survival time; treatment outcome; wound dehiscence; wound infection; Adult; Aged; Follow-Up Studies; Graft Rejection; Graft Survival; Head and Neck Neoplasms; Humans; Liver Cirrhosis; Male; Microcirculation; Middle Aged; Postoperative Complications; Reconstructive Surgical Procedures; Retrospective Studies; Risk Assessment; Surgical Flaps; Survival Rate
Type
journal article