1.
Name some common fasciocutaneous, musculocutaneous and osseocutaneous free flaps used in H&N reconstructions. What is the blood supply (and nerve, if applicable) to each.
2.
Discuss the indications and advantages of free tissue transfer in H&N reconstruction. Any contraindications?
3.
What is an angiosome? What are choke vessels?
4.
What is ischemia-reperfusion injury? What is the no-reflow phenomenon?
5.
Discuss the technical aspects of the microvascular anastomosis: Do you use more than one vien, end to side vs end to end, hand sew vs coupler?
6.
What vasodilator/anticoagulant will you use intraoperatively?
Reference(s):
Vargas, C. R., Iorio, M. L., & Lee, B. T. (2015). A Systematic Review of Topical Vasodilators for the Treatment of Intraoperative Vasospasm in Reconstructive Microsurgery. Plastic and Reconstructive Surgery, 136(2), 411–422.
7.
Discuss the role for leeches in salvage of compromised flap. How do they work? Complications?
Reference(s):
Rizis D, Tahiri, Y, Lessard, L, Sampalis, J.S., et al. (2011). Leech Therapy in Digital Replantation/Revascularization: A Review of 760 Consecutive Digits. Plastic and Reconstructive Surgery, 128(4S):76-77.
Whitaker, I.S., Oboumarzouk, O, Rozen W.M., Naderi, N, et al. (2012). The efficacy of medicinal leeches in plastic and reconstructive surgery: a systematic review of 277 reported clinical cases. Microsurgery,32(3), 240-50.
8.
What is the best way to monitor free flaps? How can you tell if a flap is failing?
Reference(s):
Kiranantawat, K., Sitpahul, N., Taeprasartsit, P., Constantinides, J., Kruavit, A., Srimuninnimit, V., … Numhom, S. (2014). The first Smartphone application for microsurgery monitoring: SilpaRamanitor. Plastic and Reconstructive Surgery, 134(1), 130–139.
9.
What are the success rates of free tissue transfer (FTT) ? In radiated beds? The elderly? Smokers? Common complications of FTT?
10.
Discuss the role for anti-coagulants in free tissue transfer. What are some commonly used drugs and how do they work?
Reference(s):
Lee, K.-T., & Mun, G.-H. (2015). The efficacy of postoperative antithrombotics in free flap surgery: a systematic review and meta-analysis. Plastic and Reconstructive Surgery, 135(4), 1124–1139.
11.
Why do free flaps fail? Can they be saved?
Reference(s):
Selber, J.C., Angel, S.M.M., Liu, J, Robb, G. (2012). The survival curve: factors impacting the outcome of free flap take-backs. Plast Reconstr Surg, 130(1): 105-13.
Mirzabeigi, M.N., Wang, T, Kovach, S.J., Taylor, J.A., et al. (2012). Free flap take-back following postoperative microvascular compromise: predicting salvage versus failure. Plast Reconstr Surg, 130(3), 579-89.