Systemic Factors

In addition to the local factors reviewed previously, there are several systemic considerations that impact on a patient's ability to heal. Many of these systemic factors are related directly to the risk factors that predispose to head and neck cancer itself: heavy alcohol use and smoking. Patients who continue to smoke until surgery often not only suffer from compromised pulmonary status but are at increased risk of wound breakdown due to poor distal vascular perfusion caused by a direct nicotine effect.

Similarly, patients with a history of alcohol abuse are at an increased risk for poor wound healing due to nutritional depletion. For patients who continue to drink actively up to the time of surgery, delirium tremens also poses a concern. The signs of delirium tremens usually begin approximately 48 to 72 h postoperatively and may be life-threatening if unattended promptly. In addition to cardiopulmonary compromise, significant concern is maintained for the physical disruption of the wound by an agitated thrashing patient, particularly in the setting of a tight closure or underlying free flap.

Most head and neck cancer patients present with some degree of malnutrition. Poor oral intake due to mechanical obstruction, and/or chronic alcoholism is common. In this situation, properly diagnosing malnutrition and restoring the patient to a positive nitrogen balance becomes critical.

Other systemic conditions, such as cardiopulmonary compromise, diabetes mellitus, chronic steroid use, hypothyroidism, or other conditions leading to immune system deficiency should also be addressed in the preoperative evaluation and followed closely postoperatively.

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