INTRAOPERATIVE MANAGEMENT OF FREE FLAPS SURVEY

Transcription

1 INTRAOPERATIVE MANAGEMENT OF FREE FLAPS SURVEY Dear Esteemed Colleague, You are being contacted at the e mail address identified in your professional organization directory to participate in this important study regarding current practices for management of hemodynamic instability during microsurgical free tissue transfer. Following a difficult case involving hypotension and fluid overload, we realized that a consensus regarding standard practice for these situations is not readily available. We hope to receive completed questionnaires from 400 microvascular surgeons across the United States, so your answers are very important to us. Of course, you have a choice whether or not to participate in this anonymous survey; your response to the survey is anonymous and all results will only be disclosed in aggregate. No identifying information about you will appear or be used in research documents, presentations or publications. The research team will not know that any information you provided came from you, nor even whether you participated. If you do participate, you are free to skip any questions or discontinue at any time. There are no anticipated risks to participating in this study. The survey will take about 3 minutes to complete. There are no costs to you for participating in the study, nor will you receive any reward for participating in the study. If you have questions about the study, please feel free to contact Lesley Wong, M.D., FACS at lesley.wong@uky.edu. If you have complaints, suggestions, or questions about your rights as a study participant, please contact the University of Kentucky Office of Research Integrity at or toll free at Thank you in advance for your participation in this important study. Sincerely, Dr. Lesley Wong, M.D., FACS Associate Professor of Surgery Division of Plastic Surgery University of Kentucky Phone: (89) E mail: lesley.wong@uky.edu Page 1

2 1. How many microvascular free flaps do you perform in one year? < >48 None, but I feel knowledgeable enough to complete this survey None, and I do not wish to participate Page 2

3 2. What is the lower limit of the following hemodynamic parameters that you consider acceptable intraoperatively? Enter your numerical response in the fields below. systolic blood pressure mean arterial pressure 3. If arterial pressure is below this level, what is your preferred method of treatment? Rank in order of preference (with 1=first choice, = last choice) Intravascular fluids Vasopressors Inotropes Packed Red Blood Cells No treatment Page 3

4 4. If you use intravascular fluids for blood pressure support, which do you prefer? Check all that apply. LR NS Hetastarch Albumin Dextran 40. If you use a vasopressor for blood pressure support, which one do you use? Check all that apply. Phenylephrine Norepinephrine Dopamine. If you use an inotrope for blood pressure support, which one do you use? Check all that apply. Dobutamine Epinephrine Page 4

5 7. What is the lowest acceptable intraoperative hematocrit you would accept in an otherwise healthy patient undergoing a free flap operation? Enter your numerical response in the field below. hematocrit 8. With respect to flap viability, rate the following on a scale of 1, with 1 being not important and being very important Maintaining normothermia in the patient Keeping the room warm Maintaining a high PaO2 (>400 mmhg) Elevating the PaCO2 (>0 mmhg) Use of intentional hemodilution (to decrease Hct) Use of regional anesthesia during free flaps to the extremities, to produce sympathetic blood intraand post operatively 9. If you use intentional hemodilution, to what level do you decrease the hematocrit? Enter your numerical response in the field below. hematocrit 10. Rate the following methods used to assess flap viability on a scale of 1, with 1 being not important and being very important Appearance Doppler signal in artery and vein Implantable Doppler probe Laser Doppler Pulse Oximeter Page

6 11. What percentage of your microvascular cases receives vasoactive drugs during the surgery? Enter your numerical response in the field below. % of cases 12. Have you ever had a free flap failure which you thought was due to Yes No hypotension administration of pressors If yes, please explain. Page

7 DVT Prophylaxis 13. Do you routinely use post operative DVT prophylaxis in free flap patients? Yes No 14. If you use DVT prophylaxis, which is your preferred method? Check all that apply. SCDs Aspirin 81 mg Aspirin 32 mg Lovenox 30 mg twice a day Lovenox 40 mg once a day Subcutaneous Heparin 000 U every 8 hours 1. If you use DVT prophylaxis, at what time do you initiate therapy? Pre operatively At 12 hours post operative At 24 hours post operative After 24 hours post operative Additional comments: Page 7

8 1. Does your management for DVT prophylaxis change based on the location of your flap (i.e. head and neck, breast, lower extremity)? Yes No If yes, please explain. Page 8

9 Thank you so much for taking the time to complete our survey! 17. Please add any other comments you may wish to make in the field below. Page 9