Improving the peri-operative management of patients undergoing free tissue transfer for head and neck malignancy

Eley, Karen (2013) Improving the peri-operative management of patients undergoing free tissue transfer for head and neck malignancy. Doctoral thesis, University of East Anglia.

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Abstract

Abstract
The cohort of patients with oral malignancy is typically of advanced age with significant comorbidity.
The causative factors for such malignancies, such as tobacco and alcohol, are also
those which result in cardiovascular disease. As a result patients undergoing ablative and
reconstructive surgery, with free tissue transfer, are at considerable risk of peri-operative
morbidity and mortality from both primary and secondary disease. Free flap failure has a
significant impact upon patient outcome, with resultant delayed discharge, and increased
morbidity and mortality. By optimising co-morbidity and peri-operative factors such as fluid
balance, nutrition, coagulation and blood pressure support, the complications of complex
surgery are reduced.
The collective objectives of this thesis were to determine methods, by both routine and novel
approaches, to enhance patient care following ablative and reconstructive surgery for head and
neck malignancy.
As a result of these investigations, fluid optimisation with LiDCO monitoring, which derives
stroke volume from the blood pressure waveform, is advocated in patients undergoing ablative
and reconstructive surgery. Peri-operatively when blood pressure cannot be maintained with
fluids alone and pressor support is required, low dose noradrenaline is considered the optimal
agent in view of the improvements in flap perfusion and reliable elevation of mean arterial
pressure. Careful anticoagulation prescribing should be undertaken, with anti-Xa monitoring of
low molecular weight heparin to ensure adequate response, in combination with
thromboelastography to identify patients most at risk of thrombotic flap complications.
This thesis has made original contributions to the literature in the peri-operative management of
patients undergoing free tissue transfer following ablative surgery for head and neck malignancy
in terms of pressor support, coagulation, nutrition, fluid management and hospital admission
route. Collectively these recommendations may improve patient outcome with significant long
term benefits for both patients and the NHS.

Item Type:	Thesis (Doctoral)
Uncontrolled Keywords:	Publication
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Users 2259 not found.
Date Deposited:	06 Mar 2014 15:06
Last Modified:	06 Mar 2014 15:06
URI:	https://ueaeprints.uea.ac.uk/id/eprint/47986
DOI:

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