title: Postoperative Controversies in the Management of Free Flap Surgery in the Head and Neck.
abstract: Free tissue transfer is the gold standard for reconstructing head and neck defects. Free flap success approaches 95% in centers with experience, affording unparalleled ability to restore form and function in cancer, trauma, or other major composite tissue loss. It is critical to manage the perioperative variables that predict success; several areas of controversy have not yet reached consensus. This review focuses on postoperative anticoagulation, fluid management, and flap monitoring methods. These areas of controversy potentially influence flap survival. We review published practices considered within the standard of care, why controversy remains, and future directions to reach standardization.
authors.affiliation: Otorhinolaryngology Head and Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA. Electronic address: Steven.cannady@uphs.upenn.edu.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Cannady
authors.affiliation: Head and Neck Surgery, Department of Otorhinolaryngology Head and Neck Surgery, University of Pennsylvania, West 34th Street, Philadelphia, PA 19107, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Hatten
authors.affiliation: Department of Otolaryngology, Oregon Health Sciences University, Portland, OR 97239, USA.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D005440:Fluid Therapy; D058752:Free Tissue Flaps / Q000637:transplantation*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods*; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Flap monitoring; Fluid management; Free flap; Head and neck defect