title: Microsurgical reconstruction of the head and neck region: Current concepts of maxillofacial surgery units worldwide.
abstract: BACKGROUND
  Microvascular surgery following tumor resection has become an important field of oral maxillofacial surgery (OMFS). Following the surveys on current reconstructive practice in German-speaking countries and Europe, this paper presents the third phase of the project when the survey was conducted globally.
  
  
  METHODS
  The DOESAK questionnaire has been developed via a multicenter approach with maxillofacial surgeons from 19 different hospitals in Germany, Austria and Switzerland. It was distributed in three different phases to a growing number of maxillofacial units in German-speaking clinics, over Europe and then worldwide.
  
  
  RESULTS
  Thirty-eight units from Germany, Austria and Switzerland, 65 remaining European OMFS-departments and 226 units worldwide responded to the survey. There is wide agreement on the most commonly used flaps, intraoperative rapid sections and a trend towards primary bony reconstruction. No uniform concepts can be identified concerning osteosynthesis of bone transplants, microsurgical techniques, administration of supportive medication and postoperative monitoring protocols. Microsurgical reconstruction is the gold standard for the majority of oncologic cases in Europe, but worldwide, only every second unit has access to this technique.
  
  
  CONCLUSIONS
  The DOESAK questionnaire has proven to be a valid and well accepted tool for gathering information about current practice in reconstructive OMFS surgery. The questionnaire has been able to demonstrate similarities, differences and global inequalities.
authors.affiliation: Department of Cranio- and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: katinka.kansy@med.uni-heidelberg.de.
authors.forename: Katinka
authors.initials: K
authors.lastname: Kansy
authors.affiliation: Department of Oral and Maxillofacial Surgery, Universitätsspital Basel, University of Basel, Basel, Switzerland.
authors.forename: Andreas Albert
authors.initials: AA
authors.lastname: Mueller
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mücke
authors.affiliation: Department of Cranio- and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Koersgen
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany.
authors.forename: Klaus Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.affiliation: Department of Oral and Maxillofacial Surgery, Universitätsspital Basel, University of Basel, Basel, Switzerland.
authors.forename: Hans-Florian
authors.initials: HF
authors.lastname: Zeilhofer
authors.affiliation: Department of Oral and Maxillofacial Surgery, Aachen University Hospital, Aachen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Hölzle
authors.affiliation: Department of Oral and Maxillofacial Surgery, Dresden University Hospital, Dresden, Germany.
authors.forename: Winnie
authors.initials: W
authors.lastname: Pradel
authors.affiliation: Department of Oral and Maxillofacial Surgery, Dresden-Neustadt Hospital, Dresden, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schneider
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kolk
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hamburg University Hospital, Hamburg-Eppendorf, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Smeets
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ramon y Cajal University Hospital, Alcalá University, Madrid, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Acero
authors.affiliation: South Thames Cleft Service, Guy's and St Thomas' NHS Trust, London, UK.
authors.forename: Piet
authors.initials: P
authors.lastname: Haers
authors.affiliation: Department of Oral & Maxillofacial Surgery, Louisiana State University School of Medicine - Shreveport, USA.
authors.forename: G E
authors.initials: GE
authors.lastname: Ghali
authors.affiliation: Department of Cranio- and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hoffmann
mesh_terms: D001291:Attitude of Health Personnel; D016025:Bone Transplantation / Q000295:instrumentation; D004358:Drug Therapy; D005060:Europe; D005858:Germany; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D020407:Internet; D007430:Intraoperative Care; D008866:Microsurgery / Q000379:methods*; D008991:Monitoring, Physiologic; D000066794:Oral and Maxillofacial Surgeons / Q000523:psychology*; D009984:Orthopedic Fixation Devices; D011182:Postoperative Care; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000637:transplantation
keywords: Free tissue flaps; Head and neck oncology; Microsurgery; OSCC; Perioperative management; Questionnaire