Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 562 - файл
.pdf
Complex Head and
Neck Microvascular
Surgery
Comprehensive Management
and Perioperative Care
AnastasiyaQuimby
SatParmar
RuiFernandes
Editors
123

Complex Head and Neck Microvascular
Surgery

Anastasiya Quimby • Sat Parmar
Rui Fernandes
Editors
Complex Head and
Neck Microvascular
Surgery
Comprehensive Management
andPerioperative Care

Editors
Anastasiya Quimby
Department of Surgery, Good Samaritan
Hospital
AQ Surgery: Head and Neck,
Microvascular Institute
West Palm Beach, FL, USA
Rui Fernandes
College of Medicine
University of Florida
Jacksonville, FL, USA
Sat Parmar
Department of Oral and Maxillofacial
Surg
Queen Elizabeth Hospital Birmingham
Birmingham, UK
ISBN 978-3-031-38897-2 ISBN 978-3-031-38898-9 (eBook)
https://doi.org/10.1007/978-3-031-38898-9
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any
other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

To my son, who was with me through this entire journey. Thank
you for lighting up my world rst with your kicks and then with
your smile. You made this journey memorable and fun in more
ways than I could have ever imagined. We did it, Kai!!! Love
you so much, Mom.

Preface
Modern surgical capabilities continue to develop and improve at an accelerating rate. Whereas less than 50years ago a diagnosis of head and neck cancer
or a devastating injury destined patients to lifelong disgurement and severe
functional decits, in the recent decades, with the advent of microvascular
free tissue transfer, the prognosis for these patients is no longer that grim.
Even more fascinating, recent developments in the eld of personalized surgery with computer-aided surgical planning and custom-made hardware
allow us to perform devastating surgery with exceptional esthetic and functional outcomes due to outstanding reconstructive capabilities. We are fortunate to enjoy success rates well above 90% for microvascular tissue transfer.
However, every single head and neck microvascular surgeon is keenly aware
of the disastrous implications affecting patients’ life expectancy and quality
of life if reconstruction failure occurs. The remarkably technically challenging surgery carried out successfully is just half the battle, however.
Consideration of various perioperative aspects is essential to ensuring overall
satisfactory patient outcomes.
As the eld of microvascular surgery is still relatively new, there are countless opportunities to continue to develop our understanding on how to improve
patient care and surgical outcomes.
A single source that addresses all aspects of perioperative management of
head and neck patients who underwent microvascular reconstruction does not
exist. There is a generalized effort to improve overall quality of surgical care
with initiatives such as the National Surgical Quality Improvement Program
(NSQIP) and surgical patient recovery with efforts of Enhanced Recovery
After Surgery (ERAS). These initiatives have shown signicant reduction in
complications and costs associated with the management of surgical patients
in other specialties. Most recently, in 2017, ERAS published guidelines on
the management of head and neck patients and highlighted paucity of data
regarding optimal perioperative care. Perioperative management varies
widely between hospitals and individual surgeons, and no standard guidelines aimed at optimization of patient outcomes currently exist. It has been
shown in other specialties that standardization of perioperative management
results in reduced complication rates, hospital stays, and cost.
In the following chapters, some of the world’s most experienced head and
neck microvascular surgeons share their knowledge, experience, and latest
available scientic evidence on how to avoid pitfalls in the preparation for
surgery, manage challenging intraoperative situations, and provide the most
vii

viii
effective postoperative care to our patients so that they can enjoy timely hospital discharge and return to their life.
Deepest gratitude goes out to my colleagues across the United States and
the globe for their initiative and valuable contributions.
Sincerely
West Palm Beach, FL, USA AnastasiyaQuimby
Preface

Contents
Part I Pre-operative Considerations
1 Medical Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Caitlin McMullen and Marianne Abouyared
2 Surgical Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Omar Breik and Sat Parmar
3 Preoperative Visit Counseling and Patient Education . . . . . . . . . 37
Sam R. Caruso and Anastasiya Quimby
Part II Intra-operative Considerations
4 Medical Optimization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Rusha Patel and Anastasiya Quimby
5 Surgical Optimization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Laurent Ganry and Anastasiya Quimby
6 Free Flap Considerations and Complications . . . . . . . . . . . . . . . 95
Neel Patel, Hisham Hatoum, Paul Amailuk, Arshad Kaleem,
and Ramzey Tursun
Part III Post-operative Considerations
7 Surgical Site Dressing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Dina Amin and Waleed Zaid
8 Level of Care Required for Postoperative Free
Tissue Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Samuel J. Rubin, Ryan H. Sobel, and Heather A. Edwards
9 Flap Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Madeleine P. Strohl, Rusha Patel, and Elizabeth A. Nicolli
10 Postoperative Delirium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Ashleigh Weyh and Anastasiya Quimby
11 Prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Esther Lee, Daniel A. Benito, and Punam G. Thakkar
ix

x
12 Perioperative Nutrition in Head and Neck Free Flap
Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Eric Nisenbaum and Elizabeth A. Nicolli
13 Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Joshua Isaac Reece, Heather A. Edwards, and
Nicole Z. Spence
14 Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Irina Baranskaya, Rachel Funk-Lawler, Blake Hilton, and
Rusha Patel
15 Physical and Occupational Therapy . . . . . . . . . . . . . . . . . . . . . . . 201
Juliana Gomez, Danielle Wilson, Patricia Black,
Louis Friedman, and Ansley M. Roche
16 Speech and Swallow Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Brianna N. Harris, Maggie Kuhn, Lisa Evangelista, and
Stephanie Davis
17 Surgical Site Complications and Management . . . . . . . . . . . . . . 249
Alexander Goodson, Karl Payne, Rajiv Anand, Prav Praveen,
and Sat Parmar
18 Hospital Discharge Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Waleed Zaid and Dina Amin
Contents
19 Cancer Site-Specific Discharge Planning . . . . . . . . . . . . . . . . . . . 277
Ashleigh Weyh, Alexis Linnerbur, Rachel Cantrell, and
Anthony M. Bunnell
20 Functional Rehabilitation of the Orofacial Complex. . . . . . . . . . 287
Stacey Nedrud, Sundeep Rawal, and Salam Salman
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305

Part I
Pre-operative Considerations
Соседние файлы в папке @xirurgi_2025
