在住院医师工作时间受限情况下的微血管头颈部重建手术结果
Outcomes in microvascular head and neck reconstruction in the setting of restricted residency hours.
作者信息
Park Richard Chan Woo, Bresler Amishav Y, Bansal Amy P, Baredes Soly
机构信息
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States.
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States.
出版信息
Am J Otolaryngol. 2018 Sep-Oct;39(5):522-526. doi: 10.1016/j.amjoto.2018.06.001. Epub 2018 Jun 5.
BACKGROUND
Resident duty hour restrictions can limit the frequency of resident flap checks at smaller institutions with "home" call. Institutions are compensating with adjuvant nursing flap checks as well as incorporating technology; however, this management remains controversial.
METHODS
A prospective cohort of 122 free flaps for reconstruction of the head and neck by a single surgeon. Demographic information, operative details, postoperative care, and flap outcomes were recorded.
RESULTS
Over 42 months, 122 free flaps were performed on 115 patients. The overall flap success rate was 96%. The flap success rate at 72 h was 98% and 96% at the time of discharge with reexploration rates of 11.6%. The intraoperative and postoperative salvage rates were 71% and 64.3% respectively.
CONCLUSION
Limited resident flap checks combined hourly nurse flap checks and an implantable Doppler is an effective monitoring protocol for academic programs in the setting of residency duty hour restrictions.
背景
住院医师值班时间限制可能会减少小型“驻地”呼叫机构中住院医师皮瓣检查的频率。各机构正在通过辅助护理皮瓣检查以及引入技术来进行弥补；然而，这种管理方式仍存在争议。
方法
对由一名外科医生进行的122例用于头颈部重建的游离皮瓣进行前瞻性队列研究。记录人口统计学信息、手术细节、术后护理和皮瓣结果。
结果
在42个月的时间里，对115例患者进行了122例游离皮瓣手术。皮瓣总体成功率为96%。72小时时皮瓣成功率为98%，出院时为96%，再次探查率为11.6%。术中和术后挽救率分别为71%和64.3%。
结论
在住院医师值班时间限制的情况下，有限的住院医师皮瓣检查、每小时一次的护士皮瓣检查以及植入式多普勒是学术项目的有效监测方案。
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