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Complex Head and Neck Microvascular Surgery
Comprehensive Management and Perioperative Care
AnastasiyaQuimby SatParmar RuiFernandes
Editors
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Complex Head and Neck Microvascular Surgery
Anastasiya Quimby • Sat Parmar Rui Fernandes
Editors
Complex Head and Neck Microvascular Surgery
Comprehensive Management andPerioperative 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, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms 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 specic 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 afliations.
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 50years ago a diagnosis of head and neck cancer or a devastating injury destined patients to lifelong disgurement and severe functional decits, 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 signicant 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 scientic evidence on how to avoid pitfalls in the preparation for surgery, manage challenging intraoperative situations, and provide the most
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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 AnastasiyaQuimby
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
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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