My observation now as a resident in Otolaryngology is that head and neck cancer, combined with free flap reconstruction can take over a residency in terms of labor, time in the OR, and time spent doing wound care while on call. The vast majority of us will not be doing this type of surgery in practice, so it just makes me wonder why ENT is struggling so hard to take over this reconstruction work from plastics. It is very cool surgery, but how many of us want to do this? 5%?
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The free flap thread
Started by kilroth
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I did TONS of free flaps in residency (never did the anastamosis, though). I actually think that it has helped me immensely so far. I've had several big H&N cases that I think I would have been in over my head had I not been exposed to the really big stuff in residency. Yes, flap call sucks, but it's the nature of the beast. I never did flaps with PRS, so I can't comment on their techniques, but I have seen some patients that decided to go to other big names places that PRS does the reconstruction - I thought the functional outcome was "different" from what I was used too.
Are you referring to the resection, the flap or both?
The flap. It's more the amount of time it consumes related to how much of it we will actually do in practice.
Free flaps are under the umbrella of subspecialty ENT. At our tertiary referral centers we get a ton of all this. Obviously exposure to free flaps is important, along with all the other subspecialty cases that 90% of us will end up never doing.
I guess we are complaining that the long hours of flap surgery consume time that could be spent on other areas of ENT? True that.
It is nice to be on a rotation right now where I am getting to to more general ENT cases. Also, these cases are more level appropriate for me as a junior resident, which is pretty nice. The subspecialty cases are usually for the senior residents. In a lot of cases they are really more appropriate for fellows, meaning the senior residents end up assisting the faculty.
As far as flap call, that is unfortunate. What do you do at your program? At my program, ICU nurses do flap checks hourly and we drop by 4 times a day or so.
I guess we are complaining that the long hours of flap surgery consume time that could be spent on other areas of ENT? True that.
It is nice to be on a rotation right now where I am getting to to more general ENT cases. Also, these cases are more level appropriate for me as a junior resident, which is pretty nice. The subspecialty cases are usually for the senior residents. In a lot of cases they are really more appropriate for fellows, meaning the senior residents end up assisting the faculty.
As far as flap call, that is unfortunate. What do you do at your program? At my program, ICU nurses do flap checks hourly and we drop by 4 times a day or so.
