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Related Concept Videos

Restorative Care01:19

Restorative Care

Restorative care is provided once a patient has been discharged from a healthcare facility and requires additional services. The additional services include home care, rehabilitation programs, and extended care. Restorative care centers help the patient regain their previous level of functioning or acquire a new level of functioning due to the incapacitating effects of a disease or a disability. It aims to assist patients in enhancing their quality of life by encouraging independence,...

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Operationalizing a Free Flap Program for Head and Neck Reconstruction at a Veterans Affairs Hospital.

David J Hernandez1,2, William Xu1,2, Yuli Lim1,2

  • 1Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery Houston Texas USA.

OTO Open
|September 11, 2023
PubMed
Summary

Establishing a head and neck microvascular free tissue transfer (MVFTT) program at a VA hospital is safe and effective. This program successfully facilitates timely radiotherapy and reduces readmissions for cancer patients.

Keywords:
30‐day readmissionVeteranfree flaphead and neck cancermicrovascular reconstruction

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Area of Science:

  • Surgical Oncology
  • Reconstructive Surgery
  • Healthcare Program Development

Background:

  • Head and neck cancer treatment often requires complex reconstructive procedures.
  • Microvascular free tissue transfer (MVFTT) is a cornerstone of head and neck reconstruction.
  • Optimizing care pathways, including timely adjuvant therapy and minimizing complications, is crucial for patient outcomes.

Purpose of the Study:

  • To operationalize a head and neck microvascular free tissue transfer (MVFTT) program at a Veterans Affairs (VA) hospital.
  • To ensure radiotherapy initiation within 6 weeks post-surgery for cancer patients.
  • To minimize 30-day readmission rates.

Main Methods:

  • Retrospective analysis of consecutive head and neck MVFTT cases from May 2017 to April 2022.
  • Data collection included demographics, disease characteristics, operative details, and postoperative outcomes from electronic medical records.
  • Comparison of 30-day readmission rates with published literature.

Main Results:

  • 141 MVFTT procedures were performed; 84% for oncologic resections.
  • Low rates of total flap loss (<1%), partial flap loss (3.5%), and fistula (2.3%).
  • 30-day readmission rate was 6.4%, significantly lower than literature (13-20%). 76% of patients started postoperative radiotherapy within 42 days.

Conclusions:

  • Operationalizing a head and neck MVFTT program within a VA setting is safe and feasible.
  • The program facilitates successful multimodal treatment delivery for head and neck cancer patients.
  • The established infrastructure can be expanded for managing treatment sequelae and nononcologic conditions.