Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Perioperative management of facial reconstruction surgery in patients with end-stage renal disease undergoing dialysis

  • Chan Woo Jung (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine) ;
  • Yong Chan Bae (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine)
  • Received : 2024.01.28
  • Accepted : 2024.04.19
  • Published : 2024.04.20
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The rising incidence of dialysis-dependent end-stage renal disease (ESRD) has underscored the need for collaboration between plastic surgeons and nephrologists, particularly concerning preoperative and postoperative management for facial reconstruction. This collaboration is essential due to a scarcity of comprehensive information in this domain. Methods: A study initiated in January 2015 involved 10 ESRD cases on dialysis undergoing Mohs micrographic surgery for facial skin cancer, followed by reconstructive surgery under general anesthesia. To ensure surgical safety, rigorous measures were enacted, encompassing laboratory testing, nephrology consultations, and preoperative dialysis admission. Throughout surgery, meticulous control was exercised over vital signs, electrolytes, bleeding risk, and pain management (excluding nonsteroidal anti-inflammatory drugs). Postoperative assessments included monitoring flap integrity, hematoma formation, infection, and cardiovascular risk through plasma creatinine levels. Results: Adherence to the proposed guidelines yielded a notable absence of postoperative wound complications. Postoperative plasma creatinine levels exhibited an average decrease of 1.10 mg/dL compared to preoperative levels, indicating improved renal function. Importantly, no cardiopulmonary complications or 30-day mortality were observed. In ESRD patients, creatinine levels decreased significantly postoperatively compared to the preoperative levels (p< 0.05), indicating favorable outcomes. Conclusion: The consistent application of guidelines for admission, anesthesia, and surgery yielded robust and stable outcomes across all patients. In particular, the findings support the importance of adjusting dialysis schedules. Despite the limited sample size in this study, these findings underscore the effectiveness of a collaborative and meticulous approach for plastic surgeons performing surgery on dialysis-dependent patients, ensuring successful outcomes.

Keywords

Acknowledgement

This work was supported by a clinical research grant from Pusan National University Hospital in 2024.

References

  1. Park JH, Lee YK, Kim K, Kim DJ. Korean Society of Nephrology hemodialysis unit accreditation report (2016-2020) and future directions. Kidney Res Clin Pract 2022;41:165-74. https://doi.org/10.23876/j.krcp.21.151
  2. Ha SM, Ko DY, Jeon SY, Kim KH, Song KH. A clinical and statistical study of cutaneous malignant tumors in Busan city and the eastern Gyeongnam province over 15 years (1996~2010). Korean J Dermatol 2013;51:167-72.
  3. Park YJ, Kwon GH, Kim JO, Ryu WS, Lee KS. Reconstruction of nasal ala and tip following skin cancer resection. Arch Craniofac Surg 2019;20:382-7. https://doi.org/10.7181/acfs.2019.00486
  4. Bello AK, Alrukhaimi M, Ashuntantang GE, Basnet S, Rotter RC, Douthat WG, et al. Complications of chronic kidney disease: current state, knowledge gaps, and strategy for action. Kidney Int Suppl (2011) 2017;7:122-9. https://doi.org/10.1016/j.kisu.2017.07.007
  5. Kim HS, Chang YJ, Chung CH. Klebsiella pneumoniae necrotizing fasciitis on the upper lip in a patient with uncontrolled diabetes. Arch Craniofac Surg 2020;21:127-31. https://doi.org/10.7181/acfs.2019.00696
  6. Mathew A, Devereaux PJ, O'Hare A, Tonelli M, Thiessen-Philbrook H, Nevis IF, et al. Chronic kidney disease and postoperative mortality: a systematic review and meta-analysis. Kidney Int 2008;73:1069-81.
  7. Yuo TH, Sidaoui J, Marone LK, Avgerinos ED, Makaroun MS, Chaer RA. Limited survival in dialysis patients undergoing intact abdominal aortic aneurysm repair. J Vasc Surg 2014;60:908-13. https://doi.org/10.1016/j.jvs.2014.04.050
  8. Moran SL, Salgado CJ, Serletti JM. Free tissue transfer in patients with renal disease. Plast Reconstr Surg 2004;113:2006-11. https://doi.org/10.1097/01.PRS.0000122214.55090.16
  9. Manrique OJ, Ciudad P, Sharaf B, Martinez-Jorge J, Moran S, Mardini S, et al. Free tissue transfers for head and neck reconstruction in patients with end-stage renal disease on dialysis: analysis of outcomes using the Taiwan national health insurance research database. J Reconstr Microsurg 2017;33:587-91. https://doi.org/10.1055/s-0037-1603739
  10. Lim BJ, Shin JY, Roh SG, Lee NH, Chung YK. Clinical analysis of factors affecting the failure of free flaps used in head and neck reconstruction. Arch Craniofac Surg 2023;24:159-66. https://doi.org/10.7181/acfs.2023.00325
  11. Kim MJ, Lim H, Park DH. Current strategies for aesthetic soft tissue refinement in nasal reconstruction. Arch Craniofac Surg 2022;23:95-102. https://doi.org/10.7181/acfs.2022.00689
  12. Villa G, De Rosa S, Scire Calabrisotto C, Nerini A, Saitta T, Degl'Innocenti D, et al. Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians' perception and practice. Perioper Med (Lond) 2021;10:13.
  13. Hou J, Shang L, Huang S, Ao Y, Yao J, Wu Z. Postoperative serum creatinine serves as a prognostic predictor of cardiac surgery patients. Front Cardiovasc Med 2022;9:740425.
  14. Nasr R, Chilimuri S. Preoperative evaluation in patients with end-stage renal disease and chronic kidney disease. Health Serv Insights 2017;10:1178632917713020.
  15. Brown JH, Hunt LP, Vites NP, Short CD, Gokal R, Mallick NP. Comparative mortality from cardiovascular disease in patients with chronic renal failure. Nephrol Dial Transplant 1994;9:1136-42. https://doi.org/10.1093/ndt/9.8.1136
  16. Chee YL, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology. Br J Haematol 2008;140:496-504. https://doi.org/10.1111/j.1365-2141.2007.06968.x
  17. Gallieni M, Cozzolino M, Ronga C, Brancaccio D. Low-molecular-weight heparins should be used with caution in patients with chronic kidney disease. Nat Clin Pract Nephrol 2008;4:488-9.
  18. Fielding-Singh V, Vanneman MW, Grogan T, Neelankavil JP, Winkelmayer WC, Chang TI, et al. Association between preoperative hemodialysis timing and postoperative mortality in patients with end-stage kidney disease. JAMA 2022;328:1837-48. https://doi.org/10.1001/jama.2022.19626
  19. Choi JY, Kang YJ, Jang HM, Jung HY, Cho JH, Park SH, et al. Nafamostat mesilate as an anticoagulant during continuous renal replacement therapy in patients with high bleeding risk: a randomized clinical trial. Medicine (Baltimore) 2015;94:e2392.
  20. Chauveaux D. Preventing surgical-site infections: measures other than antibiotics. Orthop Traumatol Surg Res 2015;101(1 Suppl):S77-83. https://doi.org/10.1016/j.otsr.2014.07.028
  21. Murray MR, Saltzman MD, Gryzlo SM, Terry MA, Woodward CC, Nuber GW. Efficacy of preoperative home use of 2% chlorhexidine gluconate cloth before shoulder surgery. J Shoulder Elbow Surg 2011;20:928-33. https://doi.org/10.1016/j.jse.2011.02.018
  22. Bathini L, Jandoc R, Kuwornu P, McArthur E, Weir MA, Sood MM, et al. Clinical outcomes of failing to dose-reduce cephalosporin antibiotics in older adults with CKD. Clin J Am Soc Nephrol 2019;14:197-205. https://doi.org/10.2215/CJN.10710918
  23. Fogel MA, Nussbaum PB, Feintzeig ID, Hunt WA, Gavin JP, Kim RC. Cefazolin in chronic hemodialysis patients: a safe, effective alternative to vancomycin. Am J Kidney Dis 1998;32:401-9. https://doi.org/10.1053/ajkd.1998.v32.pm9740155
  24. Singh J, Khadka S, Solanki D, Kichloo A, Shah H, Vyas MJ, et al. Pulmonary embolism in chronic kidney disease and end-stage renal disease hospitalizations: trends, outcomes, and predictors of mortality in the United States. SAGE Open Med 2021;9:20503121211022996.
  25. Aslam S, Friedman EA, Ifudu O. Electrocardiography is unreliable in detecting potentially lethal hyperkalaemia in haemodialysis patients. Nephrol Dial Transplant 2002;17:1639-42. https://doi.org/10.1093/ndt/17.9.1639
  26. Yamada S, Inaba M. Potassium metabolism and management in patients with CKD. Nutrients 2021;13:1751.
  27. Standage BA, Schuman ES, Ackerman D, Gross GF, Ragsdale JW. Does the use of erythropoietin in hemodialysis patients increase dialysis graft thrombosis rates? Am J Surg 1993;165:650-4. https://doi.org/10.1016/S0002-9610(05)80454-4