Moisturization During Cancer Resection Reduces Complications

In This Article

Abstract and Introduction

Abstract

Background: Intraoperative tissue desiccation is a risk factor for infection and wound necrosis. We hypothesized that maintaining a moist environment in the surgical field would reduce perioperative complications in free flap reconstruction for head and neck cancer surgery.

Methods: A total of 331 patients who underwent free flap reconstruction after head and neck cancer surgery from January 2013 to December 2017 at Osaka International Cancer Institute were included in the study. We classified patients into two groups: those in whom saline was sprayed only during reconstruction (control group: 162 patients) and those in whom saline was sprayed in the surgical field intermittently during cancer resection and reconstruction (moisturized group: 169 patients). We compared perioperative complications, including intraoperative arterial anastomotic thrombosis, between the two groups. Other candidate risk factors for intraoperative arterial thrombosis that were assessed included a history of preoperative irradiation, history of neck surgery, advanced age, and flap type.

Results: Rates of abscess formation and intraoperative arterial thrombosis were significantly lower in the moisturized group than in the control group (6.5% versus 12.7%, P < 0.05 and 3.0% versus 11.1%, P < 0.01, respectively). Binomial logistic regression analysis revealed that, in addition to no moisturization during cancer resection, advanced age and jejunal flap use were significant risk factors for intraoperative arterial thrombosis.

Conclusions: Moisturization of the surgical field during cancer resection reduced the rate of perioperative complications in free flap reconstruction. Although simple, preventing desiccation of the surgical field by spraying saline solution intermittently had significant benefits on postoperative complications.

Introduction

Desiccation of the surgical field can cause tissue damage to the wound surface, increasing the risk of infection and wound margin necrosis.^[1] In the case of free flap transfer, desiccation of the surgical field can damage vessels, potentially leading to anastomotic thrombosis. At our hospital, we have been applying saline solution intermittently in the surgical field to maintain a moist environment during free flap reconstruction after head and neck cancer resection. Since 2016, we have been using this procedure both during head and neck cancer resection and reconstruction. This study aimed to assess the effects of intermittent saline application in the surgical field not only during free flap reconstruction but also during head and neck cancer resection.

Table 1. Patient Demographics
Patient Characteristics	Control Group	Moisturized Group	P
No. patients	162	169
Age (y)	64.4 ± 11.1	66.2 ± 11.5	0.75*
Gender
Men	116	131
Women	46	38
Preoperative irradiation	36 (22.2%)	53 (31.4%)	0.52†
History of neck surgery	24 (14.8%)	29 (17.2%)	0.31†

*Student t test.
†Fisher exact test.

Table 2. Flap Type
Flap Type	Control Group	Moisturized Group
Total	162	169
Anterolateral thigh flap	85	80
Rectus abdominis musculocutaneous flap	21	10
Fibula flap	3	4
Groin flap	1	1
Forearm flap	4	5
Jejunal flap	38	62
Jejunal flap + DIEP flap	10	7

DIEP, deep inferior epigastric artery perforator.

Table 3. Outcome Measures
Perioperative Complications	Control Group	Moisturized Group	P*
	162	169
Total flap loss	1 (0.6%)	1 (0.6%)	0.98
Partial flap necrosis	9 (5.6%)	8 (4.7%)	0.73
Abscess formation	21 (12.7%)	11 (6.5%)	<0.05
Cervical skin necrosis	4 (2.5%)	4 (3.1%)	0.99
Intraoperative arterial thrombosis	18 (11.1%)	5 (3.0%)	<0.01