scholarly journals The learning curve in head and neck reconstruction with microvascular free flaps: a retrospective review

2010 ◽  
Vol 4 (6) ◽  
pp. 949-954
Author(s):  
Patnarin Mahattanasakul ◽  
Veerachai Kerekhanjanarong ◽  
Porn-ake Apipan
Keyword(s):  
Learning Curve ◽  
Head And Neck ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Retrospective Review ◽  
Free Flaps ◽  
Plastic And Reconstructive Surgery ◽  
Post Surgery ◽  
Facial Plastic ◽  
Microvascular Free Flaps

Abstract Background: Tissue defect around the head and neck region is a great challenge for reconstructive surgeons. Successful outcomes of surgery is influenced by many factors such as surgical technique in recipient and donor site, meticulous microvascular anastomosis, position of vascular pedicle, and post-surgery monitoring. The learning curve is important for any new microvascular surgeons. Objectives: Evaluate the quality of training for a new otolaryngologist, head and neck surgeon, on their performance of free flaps in facial plastic and reconstructive surgery using a retrospective review. Methods: Nineteen microvascular free flaps in patients from the ENT Center of Rajavithi Hospital were reviewed between November 2008 and October 2009. Incidences of free flap survival, and partial and complete necrosis were examined. Results: Eighteen patients with microvascular free flaps had head and neck cancer. 88.9% of the patients had squamous cell carcinoma. There were nine radial forearm free flaps, five anterolateral thigh free flaps, two rectus abdominis free flap, two iliac-free flap, and one fibular-free flap. The overall success rate of the free flap reconstructions was 84%. One partial and three total necrosis were done on the 19 flaps. Conclusion: Causes of free flap failure were similar and not dependent on the experienced of the surgeons. The postgraduate training program in facial plastic and reconstructive surgery is effective in providing new microvascular surgeons the skills to perform successful microvascular and reconstructive surgeries.

scholarly journals The Use of Harmonic Scalpel for Free Flap Dissection in Head and Neck Reconstructive Surgery

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Sebastien Albert ◽  
Charles Guedon ◽  
Caroline Halimi ◽  
Jean Pierre Cristofari ◽  
Beatrix Barry
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Harmonic Scalpel ◽  
Tissue Injury ◽  
Free Flaps ◽  
Surgical Instruments ◽  
Surgical Clips ◽  
Free Flap Surgery ◽  
Surgical Clip

Surgeons conventionally use electrocautery dissection and surgical clip appliers to harvest free flaps. The ultrasonic Harmonic Scalpel is a new surgical instrument that provides high-quality dissection and hemostasis and minimizes tissue injury. The aim of this study was to evaluate the effectiveness and advantages of the ultrasonic Harmonic Scalpel compared to conventional surgical instruments in free flap surgery. This prospective study included 20 patients who underwent head and neck reconstructive surgery between March 2009 and May 2010. A forearm free flap was used for reconstruction in 12 patients, and a fibular flap was used in 8 patients. In half of the patients, electrocautery and surgical clips were used for free flap harvesting (the EC group), and in the other half of the patients, ultrasonic dissection was performed using the Harmonic Scalpel (the HS group). The following parameters were significantly lower in the HS group compared to the EC group: the operative time of flap dissection (35% lower in the HS group), blood loss, number of surgical clips and cost of surgical materials. This study demonstrated the effectiveness of the Harmonic Scalpel in forearm and fibular free flap dissections that may be extended to other free flaps.

scholarly journals Effects of COVID-19 on Facial Plastic and Reconstructive Surgery Fellowship Training and Director Practices

OTO Open ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 2473974X2110141
Author(s):  
Parsa P. Salehi ◽  
Sina J. Torabi ◽  
Yan Ho Lee ◽  
Babak Azizzadeh
Keyword(s):  
Facial Nerve ◽  
Reconstructive Surgery ◽  
Trauma Surgery ◽  
The United States ◽  
Fellowship Training ◽  
Craniofacial Surgery ◽  
Worker Safety ◽  
Plastic And Reconstructive Surgery ◽  
Facial Plastic ◽  
The Impact

Objectives The objectives of this study include characterizing the practice patterns and testing strategies of facial plastic and reconstructive surgery (FPRS) fellowship directors (FDs) secondary to COVID-19 and to quantify the impact of COVID-19 on FPRS fellowship training. Study Design Cross-sectional survey. Setting Online. Methods A survey was sent to all American Academy of Facial Plastic and Reconstructive Surgery FDs and co-FDs in September 2020. Descriptive analyses were performed. Results Of 77 eligible FDs, 45 responded (58.4%) representing a diverse group across the United States. All but 1 FD routinely screened patients for COVID-19 in the preoperative setting. FDs largely believed that universal preoperative testing was cost-effective (66.7%), improved patient safety (80.0%) and health care worker safety (95.6%), and was not burdensome for patients (53.3%). With regard to volume of cosmetic/aesthetic, reconstructive, facial nerve, and trauma surgery, FDs indicated largely no change in volume (34.9%, 71.0%, 68.4%, and 80.0%, respectively) or fellow experience (67.4%, 80.6%, 84.2%, and 80.0%). Half (50.0%) of the FDs reported decreased volume of congenital/craniofacial surgery, but 75.0% did not believe that there was a change in fellow experience. Overall, of the 15 responses indicating “worsened training” across all domains of FPRS, 14 were located in the Northeast (93.33%). Conclusions The COVID-19 pandemic has had the least impact on the volume of reconstructive procedures, facial nerve operations, and trauma surgery and a negative impact on congenital/craniofacial surgery volume, and it has accelerated the demand for cosmetic/aesthetic operations. Overall, the majority of FDs did not feel as though their fellows’ trainings would be adversely affected by the ongoing pandemic.

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