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Surgical Site Complications and Management

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Complex Head and Neck Microvascular Surgery

Abstract

Head and neck patients requiring complex reconstruction present with inherent challenges, such as presence of saliva, intricate three-dimensional anatomy, varying tissue types (mucosa, bone, skin) and not infrequently prior history of radiation, all of which increase the likelihood of wound healing issues ranging from simple incisional dehiscence to fistulas, hardware complications and delayed flap compromise.

This chapter discusses the evidence-based management of failed wound healing (dehiscence and fistula formation) and site-specific complications in major ablative and reconstructive head and neck surgery, with some additional guidance based upon the author’s own experience. The aim of this chapter is to provide an idea of when to consider ‘going back to the operating room’ and when to stick to conservative management protocols. This chapter focuses primarily upon the management of complications once they have occurred (either at the time of primary surgery or as a secondary approach) but does touch upon preventative measures. There is also an emphasis on addressing underlying causative factors, which can be corrected to encourage spontaneous healing wherever possible. Surgical site infections are discussed in the context of managing wound sinuses and fistulae but not specifically regarding the management of cellulitis and abscess.

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Authors and Affiliations

  1. Portsmouth Hospitals University NHS Trust, Portsmouth, UK

    Alexander Goodson & Rajiv Anand

  2. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Karl Payne, Prav Praveen & Sat Parmar

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  1. Alexander Goodson
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  2. Karl Payne
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  3. Rajiv Anand
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  5. Sat Parmar
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Correspondence to Alexander Goodson .

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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

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Goodson, A., Payne, K., Anand, R., Praveen, P., Parmar, S. (2023). Surgical Site Complications and Management. 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_17

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