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December 1989

Free Flap Design in Head and Neck Reconstruction to Achieve an External Segment for Monitoring

Author Affiliations

From the Departments of Otolaryngology (Drs Urken and Biller), General Surgery, Division of Plastic Surgery (Drs Weinberg and Vickery), and Oral and Maxillofacial Surgery (Dr Buchbinder), Mount Sinai Medical Center, New York, NY.

Arch Otolaryngol Head Neck Surg. 1989;115(12):1447-1453. doi:10.1001/archotol.1989.01860360049016

• Postoperative monitoring of the perfusion of a free flap used in head and neck reconstruction is vitally important in achieving a favorable outcome. There are a wide range of methods that have been advocated to assist in this surveillance. However, at this time, there is no one technique that is universally efficacious in detecting early arterial and venous occlusion. In our experience, the most reliable means of monitoring has been the clinical assessment of flap color, capillary refill, tissue turgor, and bleeding. To assess these parameters, a portion of the flap must be accessible for observation. When the defect is buried, as is often the case in head and neck reconstruction, flap design is critical to achieve a reliable external segment for monitoring. The methods for exteriorizing a well-vascularized portion of tissue in the most commonly used flaps are described.

(Arch Otolaryngol Head Neck Surg. 1989;115:1447-1453)

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