Skip to main content
SpringerLink
Log in

Medical Assessment

  • Chapter
  • First Online:
Complex Head and Neck Microvascular Surgery

  • 176 Accesses

Abstract

Head and neck microvascular reconstruction with free tissue transfer is a complex operation with a relatively high risk of potential serious complications. Due to the risk factors that may lead to the need for head and neck free flap surgery, these patients commonly have a high burden of comorbidities that can affect their wound-healing abilities and recovery. An optimized patient is essential to prevent fistula and life-threatening wounds, to maximize postoperative function and aesthetics. There are few definitive contraindications to a surgical approach, and many preoperatively identified conditions can be managed. The surgeon must strongly consider a patient’s candidacy based on numerous clinical parameters. The doorway exam or “eyeball test” should be strongly considered; however, this must be reinforced with objective data. An analysis of medical, surgical, nutritional, and psychosocial parameters preoperatively is critical. Fortunately, with advanced planning, many conditions can be managed to minimize perioperative risk. This chapter aims to assist the surgeon in the identification and optimization of common medical comorbidities, nutrition deficiencies, substance issues, mental health concerns, and other common occurrences prior to head and neck microvascular reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bui DT, et al. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg. 2007;119(7):2092–100.

    Article  CAS  PubMed  Google Scholar 

  2. Blackwell KE. Unsurpassed reliability of free flaps for head and neck reconstruction. Arch Otolaryngol Head Neck Surg. 1999;125(3):295–9.

    Article  CAS  PubMed  Google Scholar 

  3. Kain JJ, et al. Improving head and neck microvascular reconstructive care with a novel perioperative checklist. Laryngoscope. 2021;131(7):E2251–6.

    Article  PubMed  Google Scholar 

  4. Dort JC, et al. Optimal perioperative Care in Major Head and Neck Cancer Surgery with Free Flap Reconstruction: a consensus review and recommendations from the enhanced recovery after surgery society. JAMA Otolaryngol Head Neck Surg. 2017;143(3):292–303.

    Article  PubMed  Google Scholar 

  5. Pattani KM, et al. What makes a good flap go bad? A critical analysis of the literature of intraoperative factors related to free flap failure. Laryngoscope. 2010;120(4):717–23.

    Article  PubMed  Google Scholar 

  6. Singh B, et al. Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg. 1999;103(2):403–11.

    Article  CAS  PubMed  Google Scholar 

  7. Clark JR, et al. Predictors of morbidity following free flap reconstruction for cancer of the head and neck. Head Neck. 2007;29(12):1090–101.

    Article  PubMed  Google Scholar 

  8. Serletti JM, et al. Factors affecting outcome in free-tissue transfer in the elderly. Plast Reconstr Surg. 2000;106(1):66–70.

    Article  CAS  PubMed  Google Scholar 

  9. Patel RS, et al. Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck. Head Neck. 2010;32(10):1345–53.

    Article  PubMed  Google Scholar 

  10. Noel CW, et al. Predictors of surgical readmission, unplanned hospitalization and emergency department use in head and neck oncology: a systematic review. Oral Oncol. 2020;111:105039.

    Article  PubMed  Google Scholar 

  11. Bur AM, et al. Association of Clinical Risk Factors and Postoperative Complications with Unplanned Hospital Readmission after Head and neck cancer surgery. JAMA Otolaryngol Head Neck Surg. 2016;142(12):1184–90.

    Article  PubMed  Google Scholar 

  12. Ciolek PJ, et al. Perioperative cardiac complications in patients undergoing head and neck free flap reconstruction. Am J Otolaryngol. 2017;38(4):433–7.

    Article  PubMed  Google Scholar 

  13. Sindhar S, et al. Association of Preoperative Functional Performance with Outcomes after Surgical Treatment of head and neck cancer: a clinical severity staging system. JAMA Otolaryngol Head Neck Surg. 2019;145(12):1128–36.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Stone L, et al. Association between sarcopenia and mortality in patients undergoing surgical excision of head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2019;145(7):647–54.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Alwani MM, et al. Impact of sarcopenia on outcomes of autologous head and neck free tissue reconstruction. J Reconstr Microsurg. 2020;36(5):369–78.

    Article  PubMed  Google Scholar 

  16. Fu TS, et al. Is frailty associated with worse outcomes after head and neck surgery? A Narrative Review. Laryngoscope. 2020;130(6):1436–42.

    Article  PubMed  Google Scholar 

  17. Makary MA, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901–8.

    Article  PubMed  Google Scholar 

  18. Robinson TN, et al. Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg. 2013;206(4):544–50.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fancy T, et al. Complications, mortality, and functional decline in patients 80 years or older undergoing major head and neck ablation and reconstruction. JAMA Otolaryngol Head Neck Surg. 2019;145(12):1150–7.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Benatar MJ, et al. Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases. J Plast Reconstr Aesthet Surg. 2013;66(4):478–82.

    Article  CAS  PubMed  Google Scholar 

  21. Spoerl S, et al. A decade of reconstructive surgery: outcome and perspectives of free tissue transfer in the head and neck. Experience of a single center institution. Oral Maxillofac Surg. 2020;24(2):173–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Herle P, et al. Preoperative radiation and free flap outcomes for head and neck reconstruction: a systematic review and meta-analysis. ANZ J Surg. 2015;85(3):121–7.

    Article  PubMed  Google Scholar 

  23. Bourget A, et al. Free flap reconstruction in the head and neck region following radiotherapy: a cohort study identifying negative outcome predictors. Plast Reconstr Surg. 2011;127(5):1901–8.

    Article  CAS  PubMed  Google Scholar 

  24. Smith JE, et al. Risk factors predicting aspiration after free flap reconstruction of oral cavity and oropharyngeal defects. Arch Otolaryngol Head Neck Surg. 2008;134(11):1205–8.

    Article  PubMed  Google Scholar 

  25. Smilowitz NR, Berger JS. Perioperative cardiovascular risk assessment and Management for Noncardiac Surgery: a review. JAMA. 2020;324(3):279–90.

    Article  PubMed  Google Scholar 

  26. Chang EI, et al. Analysis of risk factors for flap loss and salvage in free flap head and neck reconstruction. Head Neck. 2016;38(Suppl 1):E771–5.

    PubMed  Google Scholar 

  27. Lee TH, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043–9.

    Article  CAS  PubMed  Google Scholar 

  28. Devereaux PJ, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370(16):1494–503.

    Article  CAS  PubMed  Google Scholar 

  29. Douketis JD, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373(9):823–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Crippen MM, et al. Outcomes in head and neck free flap reconstruction among patients with a history of venous thromboembolism. Otolaryngol Head Neck Surg. 2022;166(2):267–73.

    Article  PubMed  Google Scholar 

  31. Spyropoulos AC, Douketis JD. How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood. 2012;120(15):2954–62.

    Article  CAS  PubMed  Google Scholar 

  32. Ishimaru M, et al. Risk factors for free flap failure in 2,846 patients with head and neck cancer: a National Database Study in Japan. J Oral Maxillofac Surg. 2016;74(6):1265–70.

    Article  PubMed  Google Scholar 

  33. le Nobel GJ, Higgins KM, Enepekides DJ. Predictors of complications of free flap reconstruction in head and neck surgery: analysis of 304 free flap reconstruction procedures. Laryngoscope. 2012;122(5):1014–9.

    Article  PubMed  Google Scholar 

  34. Smetana GW. Preoperative pulmonary evaluation. N Engl J Med. 1999;340(12):937–44.

    Article  CAS  PubMed  Google Scholar 

  35. Williams-Russo P, et al. Predicting postoperative pulmonary complications. Is it a real problem? Arch Intern Med. 1992;152(6):1209–13.

    Article  CAS  PubMed  Google Scholar 

  36. Kroenke K, et al. Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med. 1992;152(5):967–71.

    Article  CAS  PubMed  Google Scholar 

  37. Kroenke K, et al. Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease. Chest. 1993;104(5):1445–51.

    Article  CAS  PubMed  Google Scholar 

  38. Almquist D, et al. Preoperative pulmonary function tests (PFTs) and outcomes from resected early stage non-small cell lung cancer (NSCLC). Anticancer Res. 2018;38(5):2903–7.

    PubMed  Google Scholar 

  39. Wong DH, et al. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg. 1995;80(2):276–84.

    CAS  PubMed  Google Scholar 

  40. Bozikov K, Arnez ZM. Factors predicting free flap complications in head and neck reconstruction. J Plast Reconstr Aesthet Surg. 2006;59(7):737–42.

    Article  CAS  PubMed  Google Scholar 

  41. Valentini V, et al. Diabetes as main risk factor in head and neck reconstructive surgery with free flaps. J Craniofac Surg. 2008;19(4):1080–4.

    Article  PubMed  Google Scholar 

  42. Caputo MP, et al. Diabetes mellitus in major head and neck cancer surgery: systematic review and meta-analysis. Head Neck. 2020;42(10):3031–40.

    Article  PubMed  Google Scholar 

  43. Offodile AC 2nd, et al. Hyperglycemia and risk of adverse outcomes following microvascular reconstruction of oncologic head and neck defects. Oral Oncol. 2018;79:15–9.

    Article  CAS  PubMed  Google Scholar 

  44. Brady JS, et al. Impact of diabetes on free flap surgery of the head and neck: a NSQIP analysis. Microsurgery. 2018;38(5):504–11.

    Article  PubMed  Google Scholar 

  45. Rosado P, et al. Influence of diabetes mellitus on postoperative complications and failure in head and neck free flap reconstruction: a systematic review and meta-analysis. Head Neck. 2015;37(4):615–8.

    Article  PubMed  Google Scholar 

  46. Lazar HL, et al. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation. 2004;109(12):1497–502.

    Article  CAS  PubMed  Google Scholar 

  47. Marchant MH Jr, et al. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am. 2009;91(7):1621–9.

    Article  PubMed  Google Scholar 

  48. Buchleitner AM, et al. Perioperative glycaemic control for diabetic patients undergoing surgery. Cochrane Database Syst Rev. 2012;9:CD007315.

    Google Scholar 

  49. Setji T, et al. Rationalization, development, and implementation of a preoperative diabetes optimization program designed to improve perioperative outcomes and reduce cost. Diabetes Spectr. 2017;30(3):217–23.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Simha V, Shah P. Perioperative glucose control in patients with diabetes undergoing elective surgery. JAMA. 2019;321(4):399–400.

    Article  PubMed  Google Scholar 

  51. Pil J, et al. The incidence of hypothyroidism after radiotherapy for head and neck cancer. B-ENT. 2016;12(4):257–62.

    CAS  PubMed  Google Scholar 

  52. Ladenson PW, et al. Complications of surgery in hypothyroid patients. Am J Med. 1984;77(2):261–6.

    Article  CAS  PubMed  Google Scholar 

  53. Chen MM, et al. Predictors of readmissions after head and neck cancer surgery: a national perspective. Oral Oncol. 2017;71:106–12.

    Article  PubMed  Google Scholar 

  54. White HN, et al. Assessment and incidence of salivary leak following laryngectomy. Laryngoscope. 2012;122(8):1796–9.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Vincent A, Sawhney R, Ducic Y. Perioperative Care of Free Flap Patients. Semin Plast Surg. 2019;33(1):5–12.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Rosko AJ, et al. Hypothyroidism and wound healing after salvage laryngectomy. Ann Surg Oncol. 2018;25(5):1288–95.

    Article  PubMed  Google Scholar 

  57. Sweeny L, et al. Age and comorbidities impact medical complications and mortality following free flap reconstruction. Laryngoscope. 2021;132:772.

    Article  PubMed  Google Scholar 

  58. Acedillo RR, et al. The risk of perioperative bleeding in patients with chronic kidney disease: a systematic review and meta-analysis. Ann Surg. 2013;258(6):901–13.

    Article  PubMed  Google Scholar 

  59. Gajdos C, et al. The risk of major elective vascular surgical procedures in patients with end-stage renal disease. Ann Surg. 2013;257(4):766–73.

    Article  PubMed  Google Scholar 

  60. Leung AA, et al. Preoperative hyponatremia and perioperative complications. Arch Intern Med. 2012;172(19):1474–81.

    Article  PubMed  Google Scholar 

  61. Feinstein AJ, et al. Hyponatremia and perioperative complications in patients with head and neck squamous cell carcinoma. Head Neck. 2016;38(Suppl 1):E1370–4.

    PubMed  Google Scholar 

  62. Carniol ET, et al. Head and neck microvascular free flap reconstruction: an analysis of unplanned readmissions. Laryngoscope. 2017;127(2):325–30.

    Article  PubMed  Google Scholar 

  63. Crippen MM, et al. Association of Smoking Tobacco with Complications in head and neck microvascular reconstructive surgery. JAMA Facial Plast Surg. 2019;21(1):20–6.

    Article  PubMed  Google Scholar 

  64. Thomsen T, et al. Brief smoking cessation intervention in relation to breast cancer surgery: a randomized controlled trial. Nicotine Tob Res. 2010;12(11):1118–24.

    Article  PubMed  Google Scholar 

  65. Ehrl D, et al. Does cigarette smoking harm microsurgical free flap reconstruction? J Reconstr Microsurg. 2018;34(7):492–8.

    Article  PubMed  Google Scholar 

  66. Garip M, et al. The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis. Br J Oral Maxillofac Surg. 2021;59(3):e79–98.

    Article  CAS  PubMed  Google Scholar 

  67. Sepehripour AH, et al. Is there benefit in smoking cessation prior to cardiac surgery? Interact Cardiovasc Thorac Surg. 2012;15(4):726–32.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Truntzer J, et al. Smoking cessation and bone healing: optimal cessation timing. Eur J Orthop Surg Traumatol. 2015;25(2):211–5.

    Article  PubMed  Google Scholar 

  69. Wong J, et al. Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis. Can J Anaesth. 2012;59(3):268–79.

    Article  PubMed  Google Scholar 

  70. Kaka AS, et al. Comparison of clinical outcomes following head and neck surgery among patients who contract to abstain from alcohol vs patients who abuse alcohol. JAMA Otolaryngol Head Neck Surg. 2017;143(12):1181–6.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Crawley MB, et al. Factors associated with free flap failures in head and neck reconstruction. Otolaryngol Head Neck Surg. 2019;161(4):598–604.

    Article  PubMed  Google Scholar 

  72. Genther DJ, Gourin CG. The effect of alcohol abuse and alcohol withdrawal on short-term outcomes and cost of care after head and neck cancer surgery. Laryngoscope. 2012;122(8):1739–47.

    Article  PubMed  Google Scholar 

  73. Moon TS, et al. Recent cocaine use and the incidence of hemodynamic events during general anesthesia: a retrospective cohort study. J Clin Anesth. 2019;55:146–50.

    Article  CAS  PubMed  Google Scholar 

  74. Yu J, et al. Prognostic nutritional index is a predictor of free flap failure in extremity reconstruction. Nutrients. 2020;12(2):562.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Larsson M, et al. Eating problems and weight loss for patients with head and neck cancer: a chart review from diagnosis until one year after treatment. Cancer Nurs. 2005;28(6):425–35.

    Article  PubMed  Google Scholar 

  76. Farhangfar A, et al. Nutrition impact symptoms in a population cohort of head and neck cancer patients: multivariate regression analysis of symptoms on oral intake, weight loss and survival. Oral Oncol. 2014;50(9):877–83.

    Article  PubMed  Google Scholar 

  77. Kubrak C, et al. Nutrition impact symptoms: key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment. Head Neck. 2010;32(3):290–300.

    PubMed  Google Scholar 

  78. Dewys WD, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern cooperative oncology group. Am J Med. 1980;69(4):491–7.

    Article  CAS  PubMed  Google Scholar 

  79. Silander E, Nyman J, Hammerlid E. An exploration of factors predicting malnutrition in patients with advanced head and neck cancer. Laryngoscope. 2013;123(10):2428–34.

    Article  PubMed  Google Scholar 

  80. Mantovani G, et al. Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist. 2010;15(2):200–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Martin L, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539–47.

    Article  PubMed  Google Scholar 

  82. Tamaki A, et al. Clinical significance of sarcopenia among patients with advanced oropharyngeal cancer. Otolaryngol Head Neck Surg. 2019;160(3):480–7.

    Article  PubMed  Google Scholar 

  83. Chargi N, et al. Skeletal muscle mass is an imaging biomarker for decreased survival in patients with oropharyngeal squamous cell carcinoma. Oral Oncol. 2020;101:104519.

    Article  CAS  PubMed  Google Scholar 

  84. Chen J, Dennis SK, Abouyared M. Sarcopenia and microvascular free flap reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2021;29(5):419–23.

    Article  PubMed  Google Scholar 

  85. Swartz JE, et al. Feasibility of using head and neck CT imaging to assess skeletal muscle mass in head and neck cancer patients. Oral Oncol. 2016;62:28–33.

    Article  PubMed  Google Scholar 

  86. Bril SI, et al. Validation of skeletal muscle mass assessment at the level of the third cervical vertebra in patients with head and neck cancer. Oral Oncol. 2021;123:105617.

    Article  CAS  PubMed  Google Scholar 

  87. Bao W, et al. Exercise programs for muscle mass, muscle strength and physical performance in older adults with sarcopenia: a systematic review and meta-analysis. Aging Dis. 2020;11(4):863–73.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Jager-Wittenaar H, Ottery FD. Assessing nutritional status in cancer: role of the patient-generated subjective global assessment. Curr Opin Clin Nutr Metab Care. 2017;20(5):322–9.

    Article  PubMed  Google Scholar 

  89. Jager-Wittenaar H, et al. Self-completion of the patient-generated subjective global assessment short form is feasible and is associated with increased awareness on malnutrition risk in patients with head and neck cancer. Nutr Clin Pract. 2020;35(2):353–62.

    Article  PubMed  Google Scholar 

  90. Nakayama M, et al. The geriatric nutritional risk index as a prognostic factor in patients with advanced head and neck cancer. Laryngoscope. 2021;131(1):E151–6.

    Article  CAS  PubMed  Google Scholar 

  91. Aida T, et al. Preoperative immunonutrition decreases postoperative complications by modulating prostaglandin E2 production and T-cell differentiation in patients undergoing pancreatoduodenectomy. Surgery. 2014;155(1):124–33.

    Article  PubMed  Google Scholar 

  92. Mueller SA, et al. Effect of preoperative immunonutrition on complications after salvage surgery in head and neck cancer. J Otolaryngol Head Neck Surg. 2019;48(1):25.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Aeberhard C, et al. Effect of preoperative immunonutrition on postoperative short-term outcomes of patients with head and neck squamous cell carcinoma. Head Neck. 2018;40(5):1057–67.

    Article  PubMed  Google Scholar 

  94. Von Roenn J, Tchekmedyian S, Sheng KN. Oxandrolone in cancer-related weight loss (WL): improvement in weight, body cell mass (BCM), performance status and quality of life (QOL). Proc Am Soc Clin Oncol. 2002;21:1450.

    Google Scholar 

  95. Osmolak AM, et al. Does perioperative oxandrolone improve nutritional status in patients with cachexia related to head and neck carcinoma? Laryngoscope Investig Otolaryngol. 2019;4(3):314–8.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Misono S, et al. Incidence of suicide in persons with cancer. J Clin Oncol. 2008;26(29):4731–8.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Barber B, et al. Depression and survival in patients with head and neck cancer: a systematic review. JAMA Otolaryngol Head Neck Surg. 2016;142(3):284–8.

    Article  PubMed  Google Scholar 

  98. Mahoney J, et al. Screening for depression: single question versus GDS. J Am Geriatr Soc. 1994;42(9):1006–8.

    Article  CAS  PubMed  Google Scholar 

  99. Nease DE Jr, Maloin JM. Depression screening: a practical strategy. J Fam Pract. 2003;52(2):118–24.

    PubMed  Google Scholar 

  100. Panwar A, et al. Identification of baseline characteristics associated with development of depression among patients with head and neck cancer: a secondary analysis of a randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2018;144(11):1004–10.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Rieke K, et al. Depression and survival in head and neck cancer patients. Oral Oncol. 2017;65:76–82.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Head and Neck—Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Caitlin McMullen

  2. Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA

    Caitlin McMullen

  3. Department of Otolaryngology, Head and Neck Surgery, University of California, Davis, Davis, CA, USA

    Marianne Abouyared

  4. Veterans Affairs Northern California Health Care System, Sacramento VA Medical Center, Mather, CA, USA

    Marianne Abouyared

Authors
  1. Caitlin McMullen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marianne Abouyared
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Caitlin McMullen .

Editor information

Editors and Affiliations

  1. Department of Surgery, Good Samaritan Hospital, AQ Surgery: Head and Neck, Microvascular Institute, West Palm Beach, FL, USA

    Anastasiya Quimby

  2. Department of Oral and Maxillofacial Surg, Queen Elizabeth Hospital Birmingham, Birmingham, UK

    Sat Parmar

  3. College of Medicine, University of Florida, Jacksonville, FL, USA

    Rui Fernandes

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

McMullen, C., Abouyared, M. (2023). Medical Assessment. In: Quimby, A., Parmar, S., Fernandes, R. (eds) Complex Head and Neck Microvascular Surgery . Springer, Cham. https://doi.org/10.1007/978-3-031-38898-9_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-38898-9_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-38897-2

  • Online ISBN: 978-3-031-38898-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation