Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques.
Review published in The Laryngoscope (2007)
Abstract
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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
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...
Por qué esto importa para la hirudoterapia
Esta revisión basada en encuestas evaluó la prevalencia de capacitación microvascular en los departamentos académicos de otorrinolaringología y cirugía de cabeza y cuello en los Estados Unidos, y documentó variaciones en los cuidados postoperatorios y en los regímenes de monitorización de los trasplantes de colgajo libre. El estudio encontró que, en promedio, el 12.2% de los otorrinolaringólogos por departamento realizan colgajos libres, con una tasa de éxito promedio autoinformada del 96.4%, e identificó diversos métodos de monitorización (color del colgajo, señal Doppler, punción con aguja) y prácticas de anticoagulación (aspirina 76.5%, dextrano de bajo peso molecular 35.3%, heparina subcutánea 26.5%). Esto es tangencialmente relevante para el dominio de ASH porque la cirugía microvascular de colgajo libre es un entorno clínico en el que las sanguijuelas medicinales se usan en ocasiones de forma adyuvante para la congestión venosa. Advertencia: El resumen no menciona sanguijuelas ni hirudoterapia; la relevancia es puramente contextual al entorno quirúrgico donde puede emplearse la terapia con sanguijuelas, y no se recopilaron datos sobre el uso de sanguijuelas.
Citación
Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques.
Spiegel et al. · The Laryngoscope, 2007
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: 18 de junio de 2026