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
This survey-based review assessed the prevalence of microvascular training among academic otolaryngology–head and neck surgery departments in the United States and documented variations in postoperative care and monitoring regimens for free flap transplants. The study found that on average 12.2% of otolaryngologists per department perform free flaps, with a self-reported 96.4% average success rate, and identified diverse monitoring methods (flap color, Doppler signal, pin prick) and anticoagulation practices (aspirin 76.5%, low-molecular-weight dextran 35.3%, subcutaneous heparin 26.5%). This is tangentially relevant to ASH's domain because microvascular free flap surgery is a clinical setting where medicinal leeches are sometimes used adjunctively for venous congestion. Caveat: The abstract makes no mention of leeches or hirudotherapy; the relevance is purely contextual to the surgical environment where leech therapy may be employed, and no data on leech use were collected.
Цитирование
Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques.
Spiegel et al. · The Laryngoscope, 2007
Связанный клинический контекст
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