Delayed mobilization after microsurgical reconstruction: an independent risk factor for pneumonia.

OBJECTIVES/HYPOTHESIS: Large defects secondary to oral cancer resection are reconstructed with microsurgical free flaps. Pulmonary complications in these patients are common. Postoperative mobilization is recommended to decrease respiratory complications; however, many microsurgeons are reluctant to adopt early mobilization protocols due to the perceived risk of flap compromise. The purpose of this study was to determine the incidence of pneumonia among patients undergoing oral cancer resection and immediate free flap reconstruction and to compare the incidence of this complication between patients mobilized early (<4 days postoperative) versus later. A secondary goal was to determine whether early postoperative mobilization affected microvascular flap outcome. STUDY DESIGN: Retrospective cohort study. METHODS: Sixty-two consecutive patients treated between 2005 and 2009 with oral carcinoma resection and free flap reconstruction were studied. Information pertaining to comorbidities, postoperative care, and complications were collected. Risk factors for development of pulmonary and flap complications were analyzed. RESULTS: The incidence of pneumonia was 30.6%. Longer intensive care unit stay (P = 0.01), tracheostomy decannulation later than 10 days (P = 0.04), and longer operative times (P = 0.04) were significantly associated with pneumonia. Delayed mobilization (after day 4 postoperative) was an independent risk factor for pneumonia (OR = 4.2, 95% CI: 1.1, 17.1). Early mobilization (before day 4 postoperative) was not associated with an increased incidence of secondary flap procedures or flap failure. CONCLUSION: Late mobilization of free flap patients is an independent risk factor for developing postoperative pneumonia. Earlier mobilization does not increase flap failure rates, is safe, and should be strongly considered in all free flap patients to reduce pulmonary complications.

The epidemiological profile of the Vascular Birthmark Clinic at the Alberta Children's Hospital.

BACKGROUND: The Vascular Birthmark (VBM) Clinic at the Alberta Children's Hospital (Calgary, Alberta) is a multidisciplinary clinic dedicated to the evaluation of children with vascular anomalies. OBJECTIVE: To review the characteristics of patients seen at the VBM Clinic. METHOD: A retrospective data analysis of all pediatric patients presenting to the VBM Clinic between 1998 and 2009 was performed. Data including demographic, referring, diagnostic and treatment information were obtained from the clinic's database. RESULTS: Of 932 patients, 621 with hemangiomas and 311 patients with vascular malformations were found in the database. Hemangiomas were more commonly found in girls (68.5%), and most commonly located on the head and neck (54%), with most patients (72.6%) having only one lesion. Of the patients with hemangiomas, 14.7% underwent diagnostic imaging investigation and 23.7% received treatment including medications, surgery, pulsed-dye laser or dressings. The sex distribution among the 311 patients with vascular malformations was almost equal. Venous malformations accounted for 38.9% of patients, isolated capillary malformations for 31.5%, lymphatic malformations for 11.6%, mixed low-flow malformations for 14.8% and arteriovenous malformations for 2.9%. Overall, 37.9% of patients underwent diagnostic imaging investigation and 42.4% received treatment - either pulsed-dye laser, surgical excision, sclerotherapy or other treatment. CONCLUSIONS: Hemangiomas and vascular malformations can occur at any anatomical site. There is a large variation in clinical presentation necessitating expertise in a variety of diagnostic approaches and treatment modalities. Vascular anomalies are best managed in a multidisciplinary setting.

HISTORIQUE: La clinique des angiomes de l'Alberta Children's Hospital de Calgary, en Alberta, est une clinique multidisciplinaire vouée à l'évaluation des enfants ayant des anomalies vasculaires. OBJECTIF: Analyser les caractéristiques des patients vus à la clinique des angiomes. MÉTHODOLOGIE: Les auteurs ont procédé à une analyse rétrospective des données de tous les patients pédiatriques qui ont consulté à la clinique des angiomes entre 1998 et 2009. Ils ont obtenu des renseignements sur la démographie, l'aiguillage, le diagnostic et le traitement dans la base de données de la clinique. RÉSULTATS: Des 932 patients, 621 ayant des hémangiomes et 311, des malformations vasculaires, faisaient partie de la base de données. Les hémangiomes s'observaient surtout chez les filles (68,5 %), sur la tête et dans le cou (54 %), et la plupart des patients (72,6 %) n'avaient qu'une lésion. Chez les patients présentant des hémangiomes, 14,7 % ont subi une exploration d'imagerie diagnostique et 23,7 % ont subi un traitement, y compris des médicaments, une opération, le laser à colorant pulsé ou des pansements. La distribution selon le sexe chez les 311 patients ayant des malformations vasculaires était presque égale. On observait des malformations veineuses chez 38,9 % des patients, des malformations capillaires isolées chez 31,5 % des patients, des malformations lymphatiques chez 11,6 % d'entre eux, des malformations mixtes à bas débit chez 14,8 % des patients et des malformations artérioveineuses, chez 2,9 % d'entre eux. Dans l'ensemble, 37,9 % des patients ont subi une exploration d'imagerie diagnostique et 42,4 % ont été traités par laser à colorant pulsé, excision chirurgicale, sclérothérapie ou un autre traitement. CONCLUSIONS: Des hémangiomes et des malformations vasculaires peuvent se manifester à n'importe quel foyer anatomique. On observe une vaste variation des présentations cliniques, qui exige des compétences à l'égard de diverses approches diagnostiques et modalités thérapeutiques. Les anomalies vasculaires sont mieux prises en charge en milieu multidisciplinaire.

A population-based study of the epidemiology of acute adult burn injuries in the Calgary Health Region and factors associated with mortality and hospital length of stay from 1995 to 2004.

INTRODUCTION: Trauma resulting from acute burns is relatively common and we wished to study the incidence, outcomes and factors related to mortality and hospital length of stay to identify potential areas of prevention and improve the care of burn-injured patients. To do so, we studied a population of adult burn injury patients from a large area of Canada (the Calgary Health Region (CHR) over a 10-year period. Burn data from this population-based sample has never been published and is not currently included in the American Burn Association Repository report. METHODS: We extracted data on all adult (>or=18 years) residents of the CHR who suffered a burn injury requiring hospital admission between January 1995 and December 2004. Of particular interest were patient demographics, incidence and mortality rates of the victims as well as any factors that were associated with mortality or increased length of hospital stay. RESULTS: A total of 928 burn-injured patients were identified. The highest incidence of burn injury admissions in the CHR occurred in 1996 (12.2 burn injury admissions per 100,000 population) and 2004 (12.3 admissions per 100,000 population). The largest number of burn injury admissions occurred during the months of July and August (23.3%), while the fewest occurred during the winter months of February and December (11.9%). Mean patient age was 45.2 years (range 18-97) and 658 (70.9%) were male. The majority of our patients were admitted with second-degree burns (48.7%) and burns of the head and neck were the most prevalent (22.2%). The mean length of hospital stay for burn patients was 20.4 days (range 1-312). Over the course of the 10 years of the study, 9 (1.0%) burn patients died during their hospital stay. In univariate analyses, burn survivors differed significantly from non-survivors with respect to mean age, burn degree, body part burned and year of admission. In adjusted analyses, survivors and non-survivors differed significantly with respect to year and month of admission, degree of burn, patient age and length of stay. Factors significantly associated with increase length of hospital stay included degree of burn, older patient age and hospital site. CONCLUSIONS: In this Canadian health region, patients who die from burns tend to be older, present to the hospital during the winter months, and suffer more acute burns to the torso or multiple body regions. Additionally, patient length of stay is influenced by older patient age and greater burn thickness.