Expanding role of otolaryngologists in microvascular reconstruction of the head and neck

Abstract

Objectives: Reconstruction of complex defects of the head and neck is best accomplished by free tissue transfer. In the past, this was performed by plastic surgeons. Recently microvascular reconstruction of the head and neck has become an otolaryngology-dominated field. The Microvascular Committee undertook a study to examine the microvascular manpower situation in the otolaryngology community. Methods: Survey with direct contact of 105 teaching programs. Results: 90% response rate (41 chairmen, 12 head and neck, 20 microvascular/reconstructive, 19 program directors). The type of specialist performing free tissue transfer changed over the past decade: orthopedics (1->1), plastic surgery (62->39), and otolaryngology (29->51). The role of otolaryngologists in free tissue transfer changed from 1990 (58 programs with no otolaryngologyist doing the reconstruction; 20 programs with 1 and 14 >2) to 2001 (18 had 0; 17 had 1;, 27 had 2; and 29 had 3). In 1990, 75 programs performed <10 flaps/year, 8 between 10–20 flaps/year, 7 between 25–40 flaps/year, and 2 >50 flaps/year. This changed in 2001 to 28 programs >10, 26 between 10–20, 17 between 25–40, and 21 >50. Examining resident education and free tissue transfer revealed that 50 programs had laboratory facilities but only 14 required residents to be trained in microvascular techniques. Residents were involved in harvesting (60), reconstruction (69), anastomosis (34), and donor closure (69). Conclusions: Microvascular reconstruction has come under the domain of otolaryngology. Manpower requirements are small, and a few programs dominate the field.