Free-Flap Reconstruction · Volume V of 5
The Postoperative Flap
Recognize, escalate, and safely manage postoperative free-flap threats—from reproducible monitoring and vascular compromise to fistula, rehabilitation, survivorship, and late dysfunction.
Orientation
About this volume
Volume V carries the reconstruction beyond the operating room, from the first handoff through late survivorship. It teaches residents to establish a flap baseline, perform a reproducible examination, interpret arterial insufficiency versus venous congestion, and escalate a concerning change while considering the entire construct and airway. Subsequent sections address return-to-OR reasoning, salivary leak and fistula, carotid-risk situations, donor-site complications, nutrition, decannulation, swallowing rehabilitation, and late pain or dysfunction. The staged timeline and tables make clear that the dominant threats change from vascular compromise to healing, function, and oncologic surveillance. It completes the series: earlier volumes select and build the reconstruction; this volume focuses on protecting, salvaging, and helping the patient use it.
After completing this volume, the resident should be able to
- Establish and document a reproducible postoperative flap baseline and examination.
- Distinguish arterial insufficiency from venous congestion and escalate concerning changes promptly.
- Organize later care around fistula risk, airway, nutrition, rehabilitation, donor morbidity, and survivorship.
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