Postoperative Urinary Complications in Head and Neck Free Flap Reconstructive Surgery

OBJECTIVE

The purpose of this study is to evaluate the postoperative urinary complications and the optimal timing of foley catheter removal in patients who underwent free flap reconstructive surgery for head and neck pathology.

METHODS

A retrospective case-control study of head and neck patients who underwent free flap reconstructive surgery at a single institution between January 2009 and December 2021 was conducted. Patient risk factors for postoperative urinary retention (POUR) were analyzed. Fisher Exact and Wilcoxon Rank Sum tests were used to evaluate rates of foley replacement, straight catheterization, and catheter-associated urinary tract infection (CAUTI) and associated risk factors.

RESULTS

Two hundred and eleven patients were included in this study. Older age, lower BMI, lower intraoperative fluid volumes, and need for straight catheterization were statistically significant for POUR requiring foley replacement. Shorter total (P = .04) and postoperative (P = .01) foley duration showed statistical significance for POUR requiring straight catheterization. About 60% of patients who had straight catheterization required a foley replacement (P < .001). Only one patient (0.5%) developed a urinary tract infection (UTI).

CONCLUSION

Foley catheter duration impacts the risk of POUR requiring straight catheterization and subsequently, foley replacement. Optimal timing for foley catheter removal in the postoperative period remains to be elucidated. Removal of catheters between 21 and 48 hours after surgery may decrease the risk of POUR without increasing the rate of CAUTI in patients with head and neck pathology undergoing free flap reconstructive surgery.

Utilizing Virtual Surgical Planning and Patient-Specific Cutting Guides as an Adjunct in Microtia Repair with Autologous Costal Cartilage Graft

Virtual surgical planning (VSP) has been applied to many aspects of head and neck reconstruction. We describe the use of VSP to create auricular templates in addition to cartilage cutting and suturing guides for microtia repair in two patients with unilateral and bilateral grade 3 microtia. Both patients had satisfactory aesthetic results. This technique allows for increased precision, may decrease operative time, and good cosmetic outcomes.

Positive and Negative Themes Depicted in Television Shows Targeted Toward Adolescents

The American Academy of Pediatrics has previously expressed concerns about the thematic content of television (TV) and the amount of time children spend viewing TV. The objective of this study was to determine the positive and negative themes depicted in a select number of TV shows targeted toward adolescents. We analyzed the thematic content depicted in the first season of 26 Netflix TV shows. The mean occurrences/h for positive and negative themes were 39.53 and 47.20, respectively. The most common positive themes were "encouragement from a friend/peer," "demonstrating honesty," and "staying true to oneself" (5.98, 5.38, and 3.72 mean occurrences/h, respectively). The most common negative themes were "dishonesty," "cursing," and "selfishness," (5.30, 4.96, and 4.85 mean occurrences/h, respectively). We suggest that health care providers become aware of TV thematic content and promote media education, and we encourage co-viewing and active mediation by parents/guardians with their children.

Violence Depicted in Superhero-Based Films Stratified by Protagonist/Antagonist and Gender

The objective of this study was to describe and quantify acts of violence depicted in a select number of superhero-based films, further stratified by protagonist/antagonist characters and gender. A total of 10 superhero-based films released in 2015-2016 were analyzed by five independent reviewers. The average number of acts of violence associated with protagonist and antagonist characters for all included films was 22.7 and 17.5 mean events per hour, respectively (p=0.019). The average number of acts of violence associated with male and female characters for all included films was 33.4 and 6.5 mean events per hour, respectively (p<0.001). The most common acts of violence for all major characters were “fighting”, “use of a lethal weapon”, “bullying/intimidation/torture”, “destruction of property”, and “murder” (14.9, 11.4, 3.5, 3.4, and 2.4 mean events per hour, respectively). Based on our sample of superhero-based films, acts of violence were associated more with protagonist characters and male characters.