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.
Original language | English (US) |
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Pages (from-to) | 1265-1277 |
Number of pages | 13 |
Journal | Laryngoscope |
Volume | 134 |
Issue number | 3 |
DOIs | |
State | Published - Mar 2024 |
Keywords
- anastomosis leak
- arterial plaque
- flap volume
- free flap
- interposition graft
- microvascular technique
- pedicle geometry
- practice length
- tension
- vessel mismatch
ASJC Scopus subject areas
- Otorhinolaryngology