Document Type
Article
Publication Date
8-23-2023
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.
Recommended Citation
Philips, Ramez; Best, Keisha A.; Agarwal, Aarti; Sagheer, Hamad; Selman, Yamil; Sweeney, Larissa; Wax, Mark; Krein, Howard; Heffelfinger, Ryan; Luginbuhl, Adam; and Curry, Joseph, "A Survey of Microvascular Technique Preferences Among American Head Neck Society Members" (2023). Department of Otolaryngology - Head and Neck Surgery Faculty Papers. Paper 94.
https://jdc.jefferson.edu/otofp/94
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License
PubMed ID
37610286
Language
English
Comments
This article is the author's final published version in The Laryngoscope, Volume 134, Issue 3, Mar 2024, Pages 1265–1277.
The published version is available at https://doi.org/10.1002%2Flary.30995. Copyright © 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.
Publication made possible in part by support through a transformative agreement between Thomas Jefferson University and the publisher.