Acute Alcohol Withdrawal and Free Flap Mandibular Reconstruction Outcomes
K. Holly Gallivan, MD, MPH;
David Reiter, MD, DMD
Arch Facial Plast Surg. 2001;3:264-266.
Objective To evaluate the effect of acute postoperative alcohol withdrawal on
survival of vascularized fibular grafts for mandibular reconstruction.
Design Retrospective case series of 17 consecutive patients.
Main Outcomes Measure Relation between flap survival and alcohol withdrawal.
Results Flap survival rate was 25% for patients who experienced delirium tremens
and 85% in the other patients. Had all flaps in patients with postoperative
alcohol withdrawal survived, the success rate would have been 89%. Flap loss
was related to acute alcohol withdrawal (P = .02,  2 analysis). The relationship between complication rate and alcohol
withdrawal was also significant, using the Fisher exact test.
Conclusions Fibular free flap reconstruction of the mandible is clearly cost-effective
when it facilitates return to social function and productivity. In our experience,
acute alcohol withdrawal in the first 72 hours after surgery is associated
with a high incidence of flap loss. Therefore, we believe that patients at
significant risk for alcohol withdrawal should undergo detoxification preoperatively.
Society's economic return for investing in free flap reconstruction comes
from minimizing convalescence and maximizing postoperative patient productivity.
This return will not be realized for poorly selected patients. We are looking
further into the effects of alcoholism on flap survival rates.
From the Department of Otolaryngology–Head and Neck Surgery,
Jefferson Medical College and Thomas Jefferson University Hospital/Jefferson
Health System, Philadelphia, Pa.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Microsurgical Tissue Transfers for Head and Neck Reconstruction in Patients with Alcohol-Induced Mental Disorder
Kuo et al.
Ann. Surg. Oncol. 2008;15:371-377.
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