Effects of frailty on patients undergoing head and neck cancer surgery with flap reconstruction: a retrospective analysis.

OBJECTIVES: To establish the implications of frailty as a predictor of outcome in patients with head and neck cancer requiring flap repair. DESIGN: Retrospective cohort. DATA SOURCE: We captured data from patients above 60 years old undergoing head and neck tumour resection and free flap reconstruction surgery between June 2019 and June 2020 at the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The data contain all treatment information. OUTCOME VARIABLES: Surgery repeated in 30 days, postoperative complications, hospital length of stay, postoperative main biochemical standards. EXPOSURE VARIABLES: Age, sex, smoking history, alcoholism history, American Society of Anesthesiologists score, National Nosocomial Infection Surveillance score and Clinical T staging were exposure variables. The frailty index is the main variable. RESULT: A total of 254 patients were included in this study. Among them, 124 patients were classified as frail, while 130 patients were classified as non-frail. We found that frail patients stayed in the hospital longer than non-frail patients after surgery (p=0.018). According to the data of 26 frail patients who directly entered the intensive care unit (ICU), we found that these patients had a lower leucocyte count (p=0.005). CONCLUSIONS: Frailty is a useful predictor of outcomes in patients undergoing head and neck cancer surgery with flap reconstruction. Frailty can be a clinical tool used to identify high-risk patients and guide perioperative care to optimise patient outcomes. Frail patients have better outcomes if they directly enter the ICU.

Clinical effect of reconstruction of large anterior palatal fistulae by anteriorly based dorsal tongue flaps / 口腔疾病防治

Objective@#To evaluate the feasibility and outcomes of the reconstruction of large anterior palatal fistulae by anteriorly based dorsal tongue flaps to provide a rational reference of anteriorly based dorsal tongue flaps for clinicians.@*Methods @#Five patients with anterior hernia had a defect range of 1.0 cm × 1.0 cm to 1.5 cm × 2.0 cm, and the anterior tongue was 1.3 cm × 3.5 cm to 2.0 cm × 3.5 cm. The defects were all repaired with anteriorly based dorsal tongue flaps. The clinical efficacy was evaluated after operation, including whether the mucosal flap was infected, whether there was any shedding before the pedicle, and whether there was any perforation after operation. Thereafter, patients who were satisfied with their chewing, swallowing, speech function and appearance were followed up@*Results@#All patients underwent successful reconstruction of palatal defects by anteriorly based tongue flaps, and no case of spontaneous detachment of the tongue flap occurred. Patients with palatal fistulae were followed up for 16-28 months, and no recurrence was encountered. The operation had no effect on the speech, agitation and swallowing function of the tongue, and patients were satisfied with the appearance.@*Conclusion @#The dorsal lingual mucosal flap pedicled with the anterior tongue is a safe and reliable method for repairing large anterior palatal fistula.