Proposed Prediction Model and Nomogram for Systemic Complications in Patients Undergoing Free Flap Head and Neck Reconstruction.

Postoperative complications in head and neck surgery are well-known, but a predictive model to guide clinicians in free flap reconstructions has not been established. This retrospective single-center observational study assessed 131 patients who underwent ablative surgery and received free flap reconstruction. Primary endpoint was the occurrence of systemic complications (PSC). Secondary endpoint was the generation of a nomogram of complications according to the CDC classification. In the ordinal regression model, postoperative administration of furosemide [1.36 (0.63-2.11), p < 0.0001], blood loss [0.001 (0.0004-0.0020), p = 0.004], postoperative nadir hemoglobin [-0.03 (-0.07-0.01), p = 0.108], smoking [0.72 (0.02-1.44), p = 0.043], and type of flap reconstruction [1.01 (0.21-1.84), p = 0.014] as predictors. A nomogram with acceptable discrimination was proposed (Somer's delta: 0.52). Application of this nomogram in clinical practice could help identify potentially modifiable risk factors and thus reduce the incidence of postoperative complications in patients undergoing microvascular reconstruction of the head and neck.

Three-Dimensional Osteosynthesis Plates for the Surgical Treatment of Mandibular Fractures.

OBJECTIVES: Mandible fractures can be treated with different plate systems, that is, miniplates or three-dimensional (3D) plates. This systematic review describes the effectiveness and clinical outcomes of 3D plates used in fractures of the mandible and aims to critically evaluate its risks and benefits. MATERIALS AND METHODS: A comprehensive electronic search was conducted without date but with restriction to articles written in English. Studies in humans, including randomized or quasi-randomized controlled trials and retrospective studies, were included. The outcome parameters measured were number of patients, fracture classification, results, follow-up period, postoperative complications, and mean age of patients. Major complications were defined as those needing additional surgical intervention, for example, malocclusion, infection or plate fracture. Accordingly, complications not needing additional surgical intervention were defined as minor (ie, dehiscence, trismus). RESULTS: Guided by the PRISMA statement and the Cochrane Handbook for Systematic Reviews of Interventions, the authors identified 44 publications with a total of 1790 patients. Among the articles selected for the final review, there were 32 reported prospective studies, 12 reported retrospective studies. Regarding the evaluation of quality, 8 studies showed a low value of the risk of bias, 17 a moderate risk, and 19 a high risk. There were statistically significant advantages for 3D plates in mandibular fractures in terms of postoperative complications, for example, wound dehiscences or plate fracture. CONCLUSIONS: The 3D plate is an effective treatment modality for mandibular fractures, with low incidence of major complications, decreased length of operation time, and increased stability of osteosynthesis.

Comparison of 2 laser fragmentation patterns used in femtosecond laser-assisted cataract surgery.

PURPOSE: To evaluate the effect of fragmentation patterns (pie pattern versus grid pattern) on effective phacoemulsification time (EPT). SETTING: Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany. DESIGN: Retrospective case series. METHODS: Eyes that had femtosecond laser-assisted cataract surgery were included. One half of the group was treated with the pie pattern. The preoperative lens density was evaluated by Scheimpflug imaging (Pentacam). Then, the eyes treated with the grid pattern were matched to the pie-pattern group based on lens density (Scheimpflug imaging). RESULTS: The study comprised 150 eyes (75 in the pie-pattern group and 75 in the grid pattern group). The mean patient age was 66 years ± 10.67 (SD). The Scheimpflug density zone was 10.05% ± 1.52%. The mean EPT was 6.63 ± 5.41 seconds for the pie pattern, significantly higher than the 4.26 ± 6.99 seconds for the grid pattern (P < .01, Wilcoxon rank-sum test). The number of eyes with EPT = 0 was significantly higher with grid pattern (37 for grid versus 1 for pie, P < .01, χ2 test). Regression analysis showed that the EPT was significantly dependent on lens density for both methods (P = .045 for pie versus P < .01 for grid). In eyes with a lens density higher than 12% (9 eyes in each group), the pie pattern showed significantly lower EPT (P = .02, Wilcoxon rank-sum test). CONCLUSIONS: In cases of low to moderate lens density, grid fragmentation pattern should be used because the EPT was significantly lower and a significantly higher number of eyes did not require further emulsification. However, in eyes with high density (>12%), pie-pattern fragmentation is recommended.