title: Microsurgical tissue transfers for head and neck reconstruction in patients with alcohol-induced mental disorder.
abstract: 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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Yur-Ren
authors.initials: YR
authors.lastname: Kuo
authors.forename: Seng-Feng
authors.initials: SF
authors.lastname: Jeng
authors.forename: Kuan-Miao
authors.initials: KM
authors.lastname: Lin
authors.forename: Szu-Jen
authors.initials: SJ
authors.lastname: Hou
authors.forename: Chih-Ying
authors.initials: CY
authors.lastname: Su
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Chien
authors.forename: Ker-Li
authors.initials: KL
authors.lastname: Hsueh
authors.forename: Eng-Yen
authors.initials: EY
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000430:Alcohol Withdrawal Delirium / Q000209:etiology / Q000601:surgery; D000437:Alcoholism / Q000150:complications*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D016896:Treatment Outcome