Page 59 - Read Online

Gidumal et al. Plast Aesthet Res 2021;8:42 Plastic and
DOI: 10.20517/2347-9264.2021.27
Aesthetic Research

Review Open Access

Enhanced recovery and medical management after
head and neck microvascular reconstruction

1
2
1
1
2
Sunder Gidumal , Douglas Worrall , Noel Phan , Anthony Tanella , Samuel DeMaria , Brett Miles 1
1
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
2
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Correspondence to: Dr. Sunder Gidumal, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at
Mount Sinai, 1 Gustave Levy Place, New York, NY 10029, USA. E-mail: Sunder.Gidumal@Mountsinai.org
How to cite this article: Gidumal S, Worrall D, Phan N, Tanella A, DeMaria S, Miles B. Enhanced recovery and medical
management after head and neck microvascular reconstruction. Plast Aesthet Res 2021;8:42. https://dx.doi.org/10.20517/2347-
9264.2021.27
Received: 24 Mar 2021 First Decision: 4 Jun 2021 Revised: 9 Jun 2021 Accepted: 17 Jun 2021 First online: 5 Jul 2021

Academic Editors: Matthew Spector, Mark K. Wax Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Protocols to enhance and expedite recovery after surgery originally developed through efforts in gastrointestinal,
colorectal, and thoracic surgery populations. Implementation of specific evidence-based interventions undertaken
in the perioperative setting has been shown to decrease the length of stay, reduce cost, and improve patient
outcomes and satisfaction. The basic tenets of enhanced recovery protocols are to reduce physiologic stress in the
perioperative setting, improve nutritional status before and after surgery, promote respiratory and physical
rehabilitation, and encourage frequent and recurring reassessment for quality improvement. Some interventions,
such as the use of deep vein thrombosis prophylaxis in the perioperative setting, are now well established across
surgical populations; however, the increased attention to these protocols has led to new innovative interventions in
the head and neck population. This review highlights these innovative interventions designed to enhance recovery
after major surgery, lends particular focus to the biological mechanisms behind these interventions, and describes
their relevance to the head and neck population.

Keywords: Enhanced recovery, fast track surgery, major head and neck surgery, preoperative carbohydrate loading,
evidence-based medicine, surgical outcomes, length of stay, cost

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.parjournal.net