A Survey of Microvascular Technique Preferences Among American Head Neck Society Members.
Publication/Presentation Date
3-1-2024
Abstract
OBJECTIVE: To identify practices in microvascular techniques in routine and challenging scenarios.
STUDY DESIGN: Cross-sectional study.
METHODS: A national survey addressing practices related to microvascular free flap reconstruction was distributed to AHNS members between October and November 2021.
RESULTS: The respondents encompassed 95 microvascular surgeons. Median years of practice was 6 (interquartile range, 2-13) and median flaps per year was 35 (22-50). Common practices in arterial anastomosis included limited cleaning of artery (84.2%), use of a double approximating clamp (64.2%), and use of interrupted suture (88.4%). Common practices in venous anastomosis included limited cleaning (89.5%), downsizing the coupler (53.7%), and coupling to two independent venous systems (47.4%). In arterial anastomosis, respondents felt that kinking (50.5%) and tension (24.2%) were the riskiest challenges. Kinking was handled by loose sutures or native tissue/dissolvable biomaterial to orient pedicle. Excess tension was handled by additional dissection. With regards to associated practices, most surgeons perform anastomosis after partial inset (52.6%), give aspirin immediately postoperatively (66.3%), reserve transfusion for hemodynamic instability (69.5%), and utilize intraoperative pressors when needed (72.6%). More senior surgeons reported placing more suture to address leaks (p = 0.004) and perform end to side anastomosis on larger vein in case of venous mismatch (p = 0.012). In cases of tension, higher volume surgeons perform more extensive dissection (p = 0.035) and end to side coupling (p = 0.029).
CONCLUSIONS: This survey of AHNS members indicates patterns of microvascular techniques in routine and challenging scenarios. There exists a variation in approaches amongst surgeons based on volume and practice length.
LEVEL OF EVIDENCE: 5 Laryngoscope, 134:1265-1277, 2024.
Volume
134
Issue
3
First Page
1265
Last Page
1277
ISSN
1531-4995
Published In/Presented At
Philips, R., Best, K. A., Agarwal, A., Sagheer, H., Selman, Y., Sweeney, L., Wax, M., Krein, H., Heffelfinger, R., Luginbuhl, A., & Curry, J. (2024). A Survey of Microvascular Technique Preferences Among American Head Neck Society Members. The Laryngoscope, 134(3), 1265–1277. https://doi.org/10.1002/lary.30995
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
37610286
Department(s)
Administration and Leadership
Document Type
Article