title: Acute alcohol withdrawal and free flap mandibular reconstruction outcomes.
abstract: OBJECTIVE
  To evaluate the effect of acute postoperative alcohol withdrawal on survival of vascularized fibular grafts for mandibular reconstruction.
  
  
  METHODS
  Retrospective case series of 17 consecutive patients.
  
  
  METHODS
  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, chi2 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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Jefferson Medical College and Thomas Jefferson University Hospital/Jefferson Health System, Pa, USA.
authors.forename: K H
authors.initials: KH
authors.lastname: Gallivan
authors.forename: D
authors.initials: D
authors.lastname: Reiter
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000430:Alcohol Withdrawal Delirium / Q000150:complications; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007902:Length of Stay; D008297:Male; D008334:Mandible / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications; D013375:Substance Withdrawal Syndrome / Q000150:complications*; D013524:Surgical Flaps / Q000098:blood supply
chemical_list: D000431:Ethanol