Original Report

Outcomes of Head and Neck Free Tissue Transfer in Renal Failure Patients

Kacie R. Oglesby MD

orcid.org/0000-0001-8600-0746

Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, U.S.A.

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Gina D. Jefferson MD,

Gina D. Jefferson MD

Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, U.S.A.

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Carissa M. Thomas MD, PhD,

Carissa M. Thomas MD, PhD

Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.

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Caitlyn Tomblin BS,

Caitlyn Tomblin BS

orcid.org/0000-0003-1174-9028

UAB Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.

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Angela Alnemri MD,

Angela Alnemri MD

Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.

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Joseph M. Curry MD,

Joseph M. Curry MD

Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.

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Caroline Bonaventure MD,

Caroline Bonaventure MD

orcid.org/0000-0002-9877-5159

Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, U.S.A.

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Larissa Sweeny MD,

Larissa Sweeny MD

Department of Otolaryngology-Head & Neck Surgery, University of Miami, Miami, Florida, U.S.A.

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Holden W. Richards BA,

Holden W. Richards BA

Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A.

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Mark Wax MD,

Mark Wax MD

Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A.

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Anne C. Kane MD,

Corresponding Author

Anne C. Kane MD

[email protected]

Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, U.S.A.

Send correspondence to Anne Kane, MD, Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, (601)-984-5456, 2500 North State Street, Jackson, MS 39216. Email: [email protected]

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Kacie R. Oglesby MD,

Kacie R. Oglesby MD

orcid.org/0000-0001-8600-0746

Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, U.S.A.

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Gina D. Jefferson MD,

Gina D. Jefferson MD

Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, U.S.A.

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Carissa M. Thomas MD, PhD,

Carissa M. Thomas MD, PhD

Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.

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Caitlyn Tomblin BS,

Caitlyn Tomblin BS

orcid.org/0000-0003-1174-9028

UAB Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.

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Angela Alnemri MD,

Angela Alnemri MD

Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.

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Joseph M. Curry MD,

Joseph M. Curry MD

Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.

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Caroline Bonaventure MD,

Caroline Bonaventure MD

orcid.org/0000-0002-9877-5159

Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, U.S.A.

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Larissa Sweeny MD,

Larissa Sweeny MD

Department of Otolaryngology-Head & Neck Surgery, University of Miami, Miami, Florida, U.S.A.

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Holden W. Richards BA,

Holden W. Richards BA

Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A.

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Mark Wax MD,

Mark Wax MD

Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A.

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Anne C. Kane MD,

Corresponding Author

Anne C. Kane MD

[email protected]

Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, U.S.A.

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First published: 14 July 2023

https://doi.org/10.1002/lary.30862

Citations: 2

Editor's Note: This Manuscript was accepted for publication on June 11, 2023

This article was presented at the AAO-HNSF 2022 Annual Meeting & OTO Experience, Philadelphia, PA, September 12, 2022.

The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Abstract

Objective

To assess if there is increased risk of free flap failure in renal failure patients undergoing head and neck reconstruction. We seek to primarily assess free flap outcomes based on stages of chronic kidney disease (CKD) and secondarily determine increased risk for postoperative complications.

Methods

Retrospective chart review was performed at five tertiary care centers. Patients were identified that had undergone microvascular free flap reconstruction of the head and neck with diagnosis of renal failure, classified as Stage 3 CKD or higher. Demographic data was collected. Outcomes in the postoperative period were examined.

Results

Seventy-three patients met inclusion criteria. The average patient age was 69 years with a male predominance (n = 48). The majority of patients had CKD Stage 3 (n = 52). Overall flap failure rate was 12.33% (n = 9, CKD stage 3 = 7.69%, CKD stage 4 = 30%, CKD stage 5 = 18%). There was an increased risk of flap failure on multivariate analysis for CKD stage 4/5 patients when compared to CKD 3 patients (p = 0.0095). When compared to matched controls, there was an increased risk of flap failure in CKD patients (p = 0.01) as well as an increased risk of overall complications (p < 0.0001).

Conclusions

Patients with CKD undergoing head and neck reconstruction are at a higher risk of flap failure and overall complications. When comparing CKD stages there may be increased risk of flap failure in later stages of CKD compared to CKD 3. Appropriate patient counseling is recommended pre-operatively in this patient population with consideration for regional flaps in the appropriate patient.

Level of Evidence

3 Laryngoscope, 134:688–694, 2024

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Citing Literature

Volume134, Issue2

February 2024

Pages 688-694

Outcomes of Head and Neck Free Tissue Transfer in Renal Failure Patients

Abstract

Objective

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Information

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Outcomes of Head and Neck Free Tissue Transfer in Renal Failure Patients

Abstract

Objective

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Related

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