RESUMEN
Many patients who have operations on the head and neck for skin cancer also take warfarin to prevent thromboembolic events, and there is still debate about whether treatment should be continued, adjusted, or temporarily stopped. The main concern is to balance the risk of haemorrhagic and thromboembolic events. In this prospective controlled study we compared bleeding complications in operations for skin cancer of the head and neck between 86 patients who took warfarin (100 tumours) and 87 (100 tumours) who did not. Surgeons of different grades did the operations under the guidance of the same consultant. All those on warfarin had above normal international normalised ratios (INRs) (mean (SD) 2.5 (0.51), mode 2.6, range 1.1-4.0). In the warfarin group 8% of excisions had a bleeding complication compared with 9% in the control group. One patient in each group suffered a severe bleed that required a return to theatre. The difference in tendency to bleed between the groups was not significant (p=0.30), and the site and type of reconstruction did not influence the risk of bleeding significantly. This study shows that patients on warfarin who are within the normal therapeutic range, can be operated on safely for skin cancer by all levels of trained staff.
Asunto(s)
Anticoagulantes/uso terapéutico , Procedimientos Quirúrgicos Dermatologicos/métodos , Neoplasias de Cabeza y Cuello/cirugía , Hemorragia Posoperatoria/etiología , Neoplasias Cutáneas/cirugía , Warfarina/uso terapéutico , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Estudios de Casos y Controles , Neoplasias Faciales/cirugía , Estudios de Seguimiento , Humanos , Relación Normalizada Internacional , Estudios Prospectivos , Procedimientos de Cirugía Plástica/métodos , Factores de Riesgo , Seguridad , Trasplante de Piel/métodos , Colgajos Quirúrgicos/trasplante , Tromboembolia/prevención & controlRESUMEN
We retrospectively analysed the clinicopathological profiles of all 9 patients aged 16 years and under who had had parotidectomies at York Hospital, UK from 1995 to 2009. The operations were superficial parotidectomy (n=3), partial parotidectomy (n=4), and total parotidectomy with preservation of the facial nerve (n=2). The histological diagnoses were anomalies of the remnant of the branchial arch (n=4), and pleomorphic adenoma, haemangioma, cat scratch disease, juvenile chronic parotitis, and sarcoidosis (n=1 each) The histological diagnosis matched the clinical diagnosis in only 5. The most common complication (n=6) was transient weakness of the facial nerve. Various conditions that may be difficult to diagnose clinically can affect the parotid gland in young patients and require intervention. We describe our investigations, and indications for intervention in the management of parotid disease in children.
