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Microvascular Flap Reconstruction by Otolaryngologists: Prevalence, Postoperative Care, and Monitoring Techniques
Author(s) -
Spiegel Jeffrey H.,
Polat Julia K.
Publication year - 2007
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/mlg.0b013e31802d6e66
Subject(s) - medicine , otorhinolaryngology , microvascular surgery , free flap , free flap reconstruction , head and neck , surgery , plastic surgery , microsurgery , general surgery
Background/Objectives: Microvascular “free flap” transplants have become the preferred method of reconstruction for a great variety of complicated head and neck defects. As recently as 10 years ago, having a microvascular surgeon within a department of otolaryngology was the exception rather than the rule, whereas it is our impression that today most academic programs have one or more microvascularly trained head and neck surgeons. Among microvascular surgeons, postoperative care and management regimens vary greatly. Through informal conversations, we discerned that some surgeons take a very aggressive approach to monitoring, perhaps including prolonged stays in an intensive care setting with implanted Doppler devices to monitor flap blood flow and intravenous administration of dextran or other pharmaceutical projects. Others report that patients are quickly discharged from the hospital after just aspirin and subcutaneous heparin for a few days. Some physicians perform “flap checks” hourly, whereas others have residents check only once daily. Design/Methods: We surveyed academic otolaryngology–head and neck surgery departments that sponsor residency programs in the United States to 1) determine the prevalence of microvascular trained otolaryngologists within training programs and 2) assess variations in postoperative and monitoring regimens. Results: We found that on average, 12.2% of otolaryngologists per department perform free flap transplants, and 71.6% of microvascular trained surgeons continue to do free flaps. The surgeons self reported a 96.4% average success rate and a 6.88% return rate to the operating room for complications. Monitoring methods used included flap color (used by 79.4% of surgeons), Doppler signal (79.4%), pin prick and bleeding rate (67.6%), capillary refill (61.8%), skin surface temperature (11.8%), and implanted Doppler (8.8%). Anticoagulants used included aspirin (used by 76.5% of microvascular surgeons), low‐molecular‐weight dextran (35.3%), and subcutaneous heparin (26.5%). Conclusions: Microvascular training has become commonplace in otolaryngology–head and neck surgery training programs, with more than one in eight of these academic physicians reporting microvascular training. There was no self‐reported difference in flap failure rates on the basis of postoperative care and monitoring regimen. The results of this survey suggest that a simplified consensus postoperative regimen can be recommended.