title: Variations in the postoperative management of free tissue transfers to the head and neck in the United Kingdom.
abstract: Reliable assessment of the perfusion of free tissue transfers has always been a challenge for reconstructive microsurgeons. The complexities of flap microcirculation are often difficult to assess despite all the subjective and objective examination techniques available today, particularly when the free tissue transfer is buried, and not visible for monitoring. We investigated the post-operative management of free tissue transfers to the head and neck in the United Kingdom. Selected results from our survey show that the majority of units performed between two and five free tissue transfers to the head and neck region per month (n=60, mean=4.13, range<1-12). Clinical tests were used to monitor the flaps post-operatively in all units questioned. Hand held doppler was the most commonly used adjunctive technique, being routinely used for post-operative monitoring by twenty six units, and available for use in eighteen other units with the most common indications for use were, slow capillary refill and pale colour. Frequency and location of monitoring post-operatively was highly variable. Nurses were responsible for the routine monitoring of flaps in almost every unit. Thirty four units (57%) had a written protocol in place governing the monitoring of free tissue transfers post-operatively. We note the wide variation in practice on a national level, and make certain recommendations.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Leeds General, Infirmary, Leeds, UK. iainwhitaker@fastmail.fm
authors.forename: I S
authors.initials: IS
authors.lastname: Whitaker
authors.forename: V
authors.initials: V
authors.lastname: Gulati
authors.forename: G L
authors.initials: GL
authors.lastname: Ross
authors.forename: A
authors.initials: A
authors.lastname: Menon
authors.forename: T K
authors.initials: TK
authors.lastname: Ong
mesh_terms: D002196:Capillaries / Q000000981:diagnostic imaging / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood; D006257:Head / Q000601:surgery*; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008833:Microcirculation / Q000000981:diagnostic imaging / Q000502:physiology; D009333:Neck / Q000601:surgery*; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D011182:Postoperative Care / Q000451:nursing; D012039:Regional Blood Flow / Q000502:physiology; D012881:Skin Temperature / Q000502:physiology; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D014463:Ultrasonography; D006113:United Kingdom
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen