RESUMEN
Microvascular reconstruction of the scalp is frequently indicated in patients with locally advanced tumors, among other etiologies, in a relatively high-risk, older patient population that often has multiple medical comorbidities. A retrospective analysis was performed on patients undergoing microvascular scalp reconstruction at Emory University Hospital and Grady Memorial Hospital between 2011 and 2021. Patient demographics, wound characteristics, operative details, and complications were recorded. Statistical analysis using univariate and multivariate models was performed. Forty-two patients underwent 45 microvascular scalp reconstructive procedures during the study period. The median age was 63 years. Wounds were predominantly oncologic (n=38, 84.4%) and frequently involved deeper structures [calvarium (n=38, 84.4%), dura (n=17, 37.8%)]. At a median follow-up of 350 days, 33 patients (73.3%) had healed flaps, 9 (20.0%) had wound healing issues but ultimately successful reconstruction, and 3 (6.7%) experienced flap failure. Most patients (n=33, 80.9%) were discharged home or to a rehabilitation facility, while the remaining 8 patients (19.1%) were discharged to hospice or died. The 30-day mortality was 4 patients (8.9%) and the 6-month mortality was 8 patients (20.5%). There was a statistically significant difference in 30-day mortality (P=0.0001) on univariate analysis and 6-month mortality (P=0.003) on both univariate and multivariate analysis for patients >70 years. While age >70 years is a risk factor for mortality in patients undergoing microvascular scalp reconstruction, mortality was commonly related to underlying disease processes rather than complication of surgery. Microvascular reconstruction for scalp defects has a high success rate and can be offered as a palliative procedure for patients with locally advanced cancers, advanced age, and multiple comorbidities.
RESUMEN
Background: There is a paucity in the literature concerning craniomaxillofacial trauma (CMF) in the USA. Better recognition of these fracture patterns and their management clarifies how to best evaluate and treat them. Methods: A retrospective chart review was conducted of CMF trauma patients who required surgical intervention at a level I trauma center between 2015 and 2018. Descriptive statistics and univariate and bivariate analyses were conducted (α = 0.05). Results: A total of 1001 patients were included. Most patients were Black (n = 665; 66%) and/or male individuals (n = 813; 57%) with an average age of 37 years (range 15 -110). The most common etiologies were assault (n = 471; 44%), motor vehicle collision (n = 238; 22%), and fall (n = 117; 11%). The mechanism of injury was a determinant of fracture type (P = 0.045). The most common CMF injuries were mandibular fracture (n = 953; 95%), maxillary fracture (n = 815; 81%), and orbital fracture (n = 206; 21%). Male sex predicted panfacial fractures (P = 0.045). Black patients experienced more severe CMF trauma compared with other races (P < 0.001). ORIF was the most common treatment for mandibular (n = 481; 73%) and maxillary (n = 62; 66%) fractures. Conclusions: Etiology and patterns of CMF trauma differ globally, with assault and motor vehicle collisions being the leading causative factors in our patient population. Patient demographics are relatively consistent worldwide, with most injuries occurring in 30- to 40-year-old men. This study offers insight into at-risk populations and guidance on their management.
