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Microsurgical Tissue Transfers for Head and Neck Reconstruction in Patients with Alcohol-Induced Mental Disorder

¹ Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan
² Department of Otolaryngology, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Chang Gung University College of Medicine, Niao-Sung Hsiang, Taiwan
³ Department of Psychiatrics, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Chang Gung University College of Medicine, Niao-Sung Hsiang, Taiwan
⁴ Department of Radio-oncology, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Chang Gung University College of Medicine, Niao-Sung Hsiang, Taiwan

Correspondence: Address correspondence and reprint requests to: Seng-Feng Jeng, MD, FACS; E-mail: t1207816{at}ms22.hinet.net

Background: Free tissue transfer in patients with organic mental disorder has always been known to be risky. Herein, the outcomes of free tissue transfers for head and neck reconstruction in those with alcohol-induced mental disorder were analyzed.

Materials and methods: We retrospectively reviewed and analyzed data from the past 10 years of 1,364 patients who had undergone microsurgical tissue transfers after head and neck cancer ablation. Among them, 54 patients had been diagnosed with alcohol-induced mental disorders post-operatively. Age ranged from 33 to 71 years. Alcohol-drinking history averaged 17.5 years. Reconstructive procedures included 25 forearm flaps, 13 anterolateral thigh (ALT) flaps, 10 fibula osteocutaneous flaps, and 6 double flaps (fibula+ALT). The outcomes and complications were analyzed.

Results: Onset periods ranged from the first to fourth days post-operatively. Duration of alcohol withdrawal or delirium tremens was 3–10 days. All patients gradually stabilized after immediate psychiatric consultation and intensive medical treatment. The flap survival rate in patients with alcohol withdrawal was significantly decreased in comparison with patients not suffering alcohol withdrawal (83% versus 96.4%, P < 0.001). During this critical post-operative period, 28 (52%) patients with alcohol withdrawal syndrome experienced complications; 26 (48%) suffered flap-related complications, and 19 (35.2%) required additional surgery. The analytical parameters revealed that secondary operative procedures and duration of hospitalization differed significantly between the complication and non-complication groups (P < 0.001).

Conclusion: Higher rates of complications and level of critical care were needed in patients with alcohol-induced mental disorder after head and neck microsurgical reconstructions. Treatment requires a multidisciplinary approach, rapid diagnosis, and intensive medical care.

Key Words: Head and neck cancer ablation • Alcohol-induced mental disorders • Free tissue transfers