I Sense a Disturbance in the Flap: Late Issues and When to Intervene

Saturday, September 28, 2024

2:30 PM – 3:30 PM EDT

Location: MBCC, 209

CME/MOC Credit: 1

Disclosure(s):

Mark K. Wax, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Judith M. Skoner, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

PROGRAM DESCRIPTION: Current free flap success rates of the head and neck exceed 95% at most institutions. Additionally, there has been a shift in timing of flap failure from the immediate 72 hour window to beyond a week or more. Detection of flap issues beyond the 72 hour window has been made more easily due to technologies such as implantable dopplers that confirm blood inflow and outflow in real time. Acute flap issues are more easily categorized into arterial or venous complications, and therefore management including revision of the microvascular anastomosis and/or leech therapy are more standardized. However, late flap issues may involve poor flap appearance due to infection, chyle leak, seroma, or perhaps late arterial or venous clotting due to hypercoaguability. When to intervene, how to intervene, and the benefit of additional measures such as leeching, release of inset sutures, debridement, are not well agreed upon by microvascular surgeons.

Therefore, the purpose of this panel is to present senior surgeons with real-world case scenarios of flap complications outside of the immediate 72 hour window to categorize unexpected issues and solicit successful management measures for these uncommon scenarios.

Learning Objectives:

Review real-world situations of change in flap exam causing clinical concern beyond the 72 hour window.
Identify specific explanations of flap issues by senior microvascular surgeon panelists.
Discuss management techniques including but not limited to surgical versus bedside techniques, packing techniques, role of leech therapy (timing and duration), or additional surgical measures.

Panelist(s)

Mark K. Wax, MD

Professor Otolaryngology/Maxillofacial Surgery, Program Director
OHSU
Portland, OR, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Judith M. Skoner, MD

Assistant Professor
Medical University of South Carolina
Charleston, SC, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Moderator(s)

John Pang, MD

Assistant Professor
LSU Health Shreveport
Shreveport, Louisiana, United States

Disclosure information not submitted.

Panelist(s)

Mauricio A. Moreno, MD

Professor
University of Arkansas for Medical Sciences (UAMS)
Little Rock, AR, United States

Disclosure information not submitted.