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.
Резюме
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...
Почему это важно для гирудотерапии
Этот обзор на основе опроса оценивал распространённость обучения микрососудистой хирургии в академических отделениях оториноларингологии — хирургии головы и шеи в США и задокументировал различия в послеоперационном уходе и протоколах мониторинга свободных лоскутных трансплантатов. В исследовании было установлено, что в среднем 12,2% оториноларингологов в каждом отделении выполняют операции с использованием свободных лоскутов, при этом средний показатель успешности по самоотчёту составил 96,4%, а также выявлены разнообразные методы мониторинга (цвет лоскута, допплеровский сигнал, укол иглой) и практики антикоагулянтной терапии (аспирин 76,5%, низкомолекулярный декстран 35,3%, подкожный гепарин 26,5%). Это имеет косвенное отношение к предметной области ASH, поскольку микрососудистая хирургия свободными лоскутами является клинической ситуацией, где медицинские пиявки иногда применяются в качестве вспомогательного средства при венозном застое. Оговорка: В резюме нет упоминания пиявок или гирудотерапии; релевантность носит чисто контекстуальный характер применительно к хирургической среде, где может применяться терапия пиявками, и никаких данных об использовании пиявок не собиралось.
Цитирование
Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques.
Spiegel et al. · The Laryngoscope, 2007
Связанный клинический контекст
Узнайте, как это исследование связано с клинической практикой
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