title: Microvascular reconstruction in elderly oral cancer patients: does diabetes status have a predictive role in free flap complications?
abstract: OBJECTIVE
  Flap complications still present challenges in the field of microsurgical reconstruction. The aim of this study was to explore the role of diabetes mellitus in free flap prognosis in elderly patients (≥60 years) after oral tumor resection.
  
  
  METHODS
  The data of aged oral cancer patients who had undergone reconstructions with free flaps in our institution were gathered in this retrospective cohort study. The samples were classified into diabetic and nondiabetic groups. The predictive roles of diabetes status and other factors in free flap prognosis were analyzed. The primary outcome variable was the presence of flap complications, which was subdivided into major (requiring re-exploration or local surgery) and minor (dressing or drug treatment) groups. Major complications were defined as the second outcome variable. Univariate and multivariable analyses were used for data statistics.
  
  
  RESULTS
  A total of 309 patients (176 men [57%] and 133 women [43%]) aged 60 years or older were included in this study. There were 105 diabetic patients (34%) and 204 nondiabetic patients (66%). A total of 75 flap complications occurred during the perioperative period, with an overall incidence of 24.3% (44 diabetic patients [41.9%] and 31 nondiabetic patients [15.2%], P ≤ .001). The odds of susceptibility for flap complication development in elderly diabetic patients was 3.413 times that of nondiabetic patients (odds ratio, 3.413; P ≤ .001). Of 75 flap complications, 43 (13.9%) were deemed major complications (24 diabetic patients [22.9%] and 19 nondiabetic patients [9.3%], P ≤ .001). This statistical association was further confirmed by multivariate analysis (odds ratio, 2.885; P = .002).
  
  
  CONCLUSIONS
  Diabetes mellitus increases the risk of the development of free flap complications in elderly patients when dealing with oral reconstruction after tumor removal.
authors.affiliation: Resident doctor, Department of Oromaxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhonglong
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Resident doctor, Department of Oromaxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhuowei
authors.initials: Z
authors.lastname: Tian
authors.affiliation: Professor, Department of Oromaxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Chenping
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Professor, Department of Oromaxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Sun
authors.affiliation: Professor, Department of Oromaxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Professor, Department of Oromaxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: yuehe@sjtu.edu.cn.
authors.forename: Yue
authors.initials: Y
authors.lastname: He
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000150:complications / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures