Consideration in Microvascular Reconstruction during Times of Social Crises: Perspectives on Resource Utilization

Abstract

Reconstruction of head and neck surgical defects can be a complicated, costly process. While the era of cost-effective medicine has begun to broadly question the necessity of high-cost care, times of extraordinary sociomedical demand bring increased scrutiny to even routine costs and resource utilization. Within this context, we reviewed the advantages, drawbacks, and financial costs of both regional and free flap reconstructions, namely the decreased costs and hospital resource utilization that may be associated with reconstruction using regional flaps. Although beset by reports of partial necrosis in certain regional flaps—particularly the submental island, cervicofacial advancement, and supraclavicular artery island flaps—many reports have demonstrated complication and flap failure rates equivalent to those of free flaps. Additionally, regional flaps have been associated with decreased costs for hospital stay, most notably in cases of postoperative complications. In cases necessitating free flap reconstruction, cost-savings strategies such as bypassing postoperative intensive care unit admissions have been shown to provide satisfactory, safe outcomes. As the head and neck surgeon continues to adapt to the medical pressures of a global pandemic, resource-sparing approaches to oncologic care will persist in their newfound importance.

A combination of two regional flaps for the complex reconstruction after head and neck cancer surgery as an alternative approach during the COVID‑19 pandemic: A case report

“…The submental flap, used in our patient for the reconstruction of the buccal and retromolar area, is another flap that has been reconsidered during the last two years as a valid alternative for free flap reconstruction techniques ( 13 ). This flap was designed and reported by Martin et al ( 29 ) as an alternative to free flaps for the reconstruction of oral cavity defects.…”

“…However, in most cases, patients which undergo head and neck surgeries with free vascularized flap reconstructions, require specific postoperative care from several h up to days ( 11 ), which represented an enormous challenge during the last two years since the COVID-19 pandemic outbreak, due to both lack of available beds in intensive care units and the deficit of qualified medical staff which was massively redirected for the treatment and surveillance of COVID-19 patients ( 12 ). Unfortunately, this new context was associated with concerning reports regarding access to adequate medical care for patients with HNC eligible for radical surgeries ( 13 ). An increase in avoidable deaths associated with malignancy is expected in the following years, as a consequence of the limited access to medical care that patients faced during the last two years of the COVID-19 pandemic ( 14 ).…”