Outcomes in microvascular head and neck reconstruction in the setting of restricted residency hours

• Published in: American journal of otolaryngology Vol. 39; no. 5; pp. 522 - 526
• Main Authors: Park, Richard Chan Woo, Bresler, Amishav Y., Bansal, Amy P., Baredes, Soly
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2018; Elsevier Limited
• Subjects: Chemotherapy; Cohort Studies; Databases, Factual; Demographics; Diabetes; Education, Medical, Graduate - methods; Failure; Female; Fistula; Flaps; Follow-Up Studies; Free Tissue Flaps - blood supply; Free Tissue Flaps - transplantation; Graft Survival; Head and neck; Head and Neck Neoplasms - surgery; Heart attacks; Hospitals, University; Humans; Hypertension; Intensive care; Internship and Residency - methods; Male; Microvasculature; Monitoring, Physiologic - methods; Nursing; Otolaryngology; Patients; Postoperative Care - standards; Postoperative Care - trends; Prospective Studies; Reconstruction; Reconstructive Surgical Procedures - education; Risk Factors; Salvage; Success; Surgery; Time Factors; Treatment Outcome; Ireland
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2018.06.001

Resident duty hour restrictions can limit the frequency of resident flap checks at smaller institutions with “home” call. Institutions are compensating with adjuvant nursing flap checks as well as incorporating technology; however, this management remains controversial. A prospective cohort of 122 free flaps for reconstruction of the head and neck by a single surgeon. Demographic information, operative details, postoperative care, and flap outcomes were recorded. Over 42 months, 122 free flaps were performed on 115 patients. The overall flap success rate was 96%. The flap success rate at 72 h was 98% and 96% at the time of discharge with reexploration rates of 11.6%. The intraoperative and postoperative salvage rates were 71% and 64.3% respectively. Limited resident flap checks combined hourly nurse flap checks and an implantable Doppler is an effective monitoring protocol for academic programs in the setting of residency duty hour restrictions.