Factors Affecting Volume Change of Anterolateral Thigh Flap in Head and Neck Defect Reconstruction.

PURPOSE: The anterolateral thigh flap (ALTF) volume will decrease over time after surgery. We measured and identified the risk factors for postoperative volume changes in the ALTF. MATERIALS AND METHODS: We designed and performed a retrospective cohort study of patients who had undergone reconstruction of oral and maxillofacial defects using ALTFs at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June 2012 to December 2018. We measured the volume of the ALTFs at 1, 3, 6, 12, and 24 months postoperatively; the flap volume at 1 month postoperatively was taken as the baseline. The primary outcome variables were the residual ALTF rates at 3, 6, 12, and 24 months postoperatively, defined as the ratio between the present volume at each month and at baseline. The primary predictor variables were the clinical variables that might be associated with ALTF volume loss. Descriptive and bivariate statistics were computed, and the P value for statistical significance was set at ≤ .05. RESULTS: The sample included 70 subjects with a mean age of 53.8 years (46 men and 24 women). The postoperative residual rates at 3, 6, 12, and 24 months were 72.3, 69.0, 67.9, and 68.7%, respectively, of the baseline volume. The use of postoperative radiotherapy (P < .01) and low body mass index (BMI; P = .006) were significantly associated with postoperative ALTF volume loss. CONCLUSIONS: The results of the present study suggest that ALTF volume shrinkage mainly occurs within 6 months postoperatively and that postoperative radiotherapy and a low BMI are risk factors for volume loss. Overcorrection should be performed to account for the shrinkage of ALTFs, and postoperative nutrition management is important to avoid ALTF volume loss.

Factors associated with follow-up attendance of patients with oral squamous cell carcinoma: A retrospective cohort study.

BACKGROUND: This study examined the postoperative follow-up attendance of oral squamous cell carcinoma (OSCC) patients, evaluated some of the factors associated with it, and assessed its relationship with early detection of postoperative disease progression. METHODS: An exploratory retrospective cohort study of 430 OSCC patients was conducted. We examined associations of follow-up attendance within the first year after surgery with selected demographic and clinical factors, and with early detection of disease progression. RESULTS: The mean number of follow-up visits within the first year after surgery was 3.9 out of the 12 recommended at our center; few patients were fully adherent. Age ≥70 years, unmarried status, high education level, and negative history of surgery for premalignant or malignant lesions from oral cavity or other sites were significantly associated with lower follow-up attendance. Greater follow-up attendance was significantly associated with early detection of disease progression during the first year after surgery (p = 0.025). CONCLUSIONS: Adherence to follow-up visits was poor. Several sociodemographic and clinical factors were related to follow-up attendance, greater follow-up attendance was significantly associated with early detection of disease progression, and these should be further explored in future research.

Factors affecting postoperative sleep quality of patients undergoing flap transfer for head and neck reconstruction.

OBJECTIVES: This study aimed to examine the postoperative sleep quality of patients undergoing flap transfer for head and neck reconstruction and to identify the associated factors. MATERIALS AND METHODS: We carried out a prospective cohort study of patients who underwent flap transfer for head and neck reconstruction at our institute between August 2020 and December 2021. The insomnia severity index (ISI) was used to examine the patients' sleep quality at postoperative week 1. Patients with an ISI score ≥ 15 were recognized as suffering from significant clinical insomnia. Descriptive statistics was used to expound the postoperative sleep quality. Associations between postoperative sleep quality and clinical variables were examined using the Chi-squared test and a Binary logistics regression model to identify the associated risk factors. RESULTS: Among the 101 patients included, their average ISI score was 15.6 (range 2-25), and 62 patients (61.4%) experienced significant clinical insomnia. Anxiety (odds ratio = 8.361; 95% confidence interval: 1.001-69.837; P = 0.049) and postoperative complications (odds ratio = 6.285; 95% confidence interval: 1.941-20.351; P = 0.002) were significantly associated with postoperative insomnia of the included patients. CONCLUSION: Postoperative sleep disturbances are highly prevalent among patients undergoing flap transfer for head and neck reconstruction, for which anxiety and postoperative complications are independent risk factors. Psychotherapy is necessary for patients with anxiety symptoms and measures should be taken to minimize the postoperative complications. Moreover, pain treatment is necessary to improve postoperative sleep quality and quality of life.