Current Practices in Microvascular Reconstruction by Oral and Maxillofacial Surgeons

Sayre, Kelly S.; Kovatch, Kevin J.; Hanks, John E.; Stucken, Chaz L.; Ward, Brent B.

doi:10.1016/j.joms.2021.04.008

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…Our response rate was similar to other survey based research, and all regions were represented. [2][3][4][5] The largest demographic was 61-70 years of age. This demographic will be transitioning out of the workforce in the near future suggesting that a shortage of academic OMFS orthognathic surgeons may occur.…”

Section: Discussionmentioning

confidence: 99%

Current Orthognathic Surgery Practice Patterns Among Academic OMS

Bourne

Kinard

2023

The Cleft Palate Craniofacial Journal

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Objective Currently there is variation in perioperative care of orthognathic surgery patients and limited clinical practice guidelines. The current orthognathic surgery practice patterns among US academic OMFS training centers have not been described. The purpose of this study is to describe the practice patterns among US academic OMFS training centers. Design The study design is cross-sectional. Data was collected through a survey of the sample. Setting OMFS programs in the US. Participants Academic OMFS. 573 surgeons were contacted and 85 responses were received. Main Outcome Measure Descriptive and bivariate statistics were reported. Results Respondents were 87% male and worked in full-time academic (80%), part-time academic (19%), or military settings (1%). Thirty-one percent have practiced for 30 years or more and then 29% with 11–20 years, 18% with 21–30 years, 12% with 6–10 years and 11% with 1–5 years. Twenty-six percent of respondents perform 20–40 orthognathic surgeries a year, 22% perform less than 20 surgeries a year, 21% perform 40–60 surgeries per year, and 19% perform more than 100 surgeries per year. Intraoperatively, 48% of surgeons request a mean arterial pressure of 60–64 mmHg, 25% utilize tranexamic acid (TXA), 85% report a blood loss of less than 400 milliliters, and 93% report a blood transfusion rate of <1%. Conclusion There are variations in orthognathic surgery practice patterns with limited clinical practice guidelines. Only 13 of the 32 survey questions had a single response holding a simple majority. This study demonstrates the need for further research and evidence-based protocols and decision making.

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Section: Discussionmentioning

confidence: 99%

Current Orthognathic Surgery Practice Patterns Among Academic OMS

Bourne

Kinard

2023

The Cleft Palate Craniofacial Journal

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“…Most antithrombotic practices are based on anecdotal evidence, surgeon training tendencies, and prior use. 4 , 5 , 6 The effects of antithrombotics on free flap outcomes remain controversial, particularly regarding the effect on hematoma formation. Hematomas are the second most common cause of emergent re‐exploration of microvascular free flaps.…”

mentioning

confidence: 99%

Effect of Perioperative Antithrombotics on Postoperative Transfusion and Hematoma in Head and Neck Free Flaps

Hicks,

Vasudev,

Bishop

et al. 2023

OTO Open

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ObjectiveTo explore if antiplatelet or anticoagulant therapy increases the risk of transfusion requirement or postoperative hematoma formation in patients undergoing microvascular reconstruction for head and neck defects.Study DesignRetrospective cohort study.SettingDepartments of Otolaryngology–Head and Neck Surgery at the University of Alabama at Birmingham, the University of Colorado, and the University of California Irvine.MethodsA multi‐institutional, retrospective review on microvascular reconstruction of the head and neck between August 2013 to July 2021. Perioperative antithrombotic data were collected to examine predictors of postoperative transfusion and hematoma.ResultsA total of 843 free flaps were performed. Preoperative hemoglobin, hematocrit, operative time, and flap type were positive predictors of postoperative transfusion in both bivariate (P < .0001) and multivariate analyses (P < .0001). However, neither anticoagulation nor antiplatelet therapy were predictive of postoperative transfusion rates and hematoma formation.ConclusionAntithrombotic regimens do not increase the risk of postoperative transfusion or hematoma in head and neck microvascular reconstruction. Based on this limited data, perioperative antithrombotic regimens can be considered in patients who may otherwise be at risk for these postoperative complications.

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