Free Flap Reconstruction Monitoring Techniques and Frequency in the Era of Restricted Resident Work Hours

Abstract

Academic centers rely primarily on q1h flap checks by intensive care unit nurses using physical examination and Doppler sonography. Reduced resident monitoring frequency did not alter flap salvage nor flap outcome. These findings suggest that institutions may successfully monitor free flaps with decreased resident burden.

The submental flap for head and neck reconstruction: Comparison of outcomes to the radial forearm free flap

“…The RFFF has a long track record of success and enjoys a reputation of being highly reliable. Numerous studies demonstrate success rates over 95%, with more recent large studies demonstrating success rates of 98% to 99%…”

“…It also has certain equipment requirements in terms of operating microscope and microsurgical instruments and is frequently a time‐consuming procedure, with lengthy operative times beyond the resection alone. Free flap monitoring is also required to identify flaps in distress and maintain the highest possible rate of flap survival with flap salvage . Whereas the RFFF is generally thin tissue, it frequently causes temporary compromise of the airway, necessitating either tracheotomy or prolonged intubation around the time of surgery.…”

Current practices in microvascular reconstruction in otolaryngology–head and neck surgery

“…Studies have shown that trainee involvement in MFTT cases does not impact complication rates . Furthermore, reduction in frequency of trainee free flap monitoring and increased monitoring by trained nursing staff have been described in the era of work‐hour restrictions . A wide variety of flap monitoring techniques have been described .…”

“…In the preoperative and intraoperative period, surgeon roles and surgical planning, including assessment of the anticipated anatomic and functional deficits, are critical in choosing an optimal reconstructive option. In the intraoperative and postoperative setting, differences exist in responsibilities performed by various members of the care team . Many modalities of flap monitoring exist, as well as many institutional schema regarding the optimal timing and responsible providers for flap checks .…”

“…In the intraoperative and postoperative setting, differences exist in responsibilities performed by various members of the care team . Many modalities of flap monitoring exist, as well as many institutional schema regarding the optimal timing and responsible providers for flap checks . Anesthetic/sedation plans, appropriate postoperative level of care, duration of postoperative antibiotics, and anticoagulation plans have all been studied, yet no consensus exists for these aspects of patient care following MFTT .…”