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Page 10 of 15 Gidumal et al. Plast Aesthet Res 2021;8:42 https://dx.doi.org/10.20517/2347-9264.2021.27

Accepted postoperative practices
Several perioperative interventions that have established as part of routine care in the setting of head and
neck surgery; we mention them here for completeness. Preoperatively, the benefits of cessation of alcohol
intake and smoking are widely documented; patients should be counseled to undergo these lifestyle
modifications prior to surgery and encouraged to maintain these changes even after the perioperative
period. Antibiotic prophylaxis against surgical site infections during clean-contaminated surgical cases is
well-established, with the administration of antibiotics typically 1 h prior to surgery and continued for
24 h [107-110] . Intraoperatively, the benefits of regional nerve blocks, normothermia, prophylaxis for
postoperative nausea and vomiting, and goal-directed hemodynamic therapy are published widely.
Postoperatively, prophylaxis against deep vein thrombosis is a widely accepted practice to reduce the rate of
[111]
postoperative venous thromboembolism . Although no randomized clinical trial has been conducted to
lend evidence to the utility of perioperative free flap monitoring, the practice of intensive monitoring every
1-4 h for up to 72 h after surgery has become routine [12,112-114] . Lastly, the need for and benefit of early
mobilization and pulmonary physical therapy after the surgery is commonly accepted to reduce the
incidence of postoperative vascular, musculoskeletal, and pulmonary complications [4,12,60,66-68,115-118] .

CONCLUSION
The application of ERAS protocols to head and neck surgical populations has become more widespread in
the last decade. Continued evaluation of newly developed interventions presents an ongoing opportunity to
reduce the length of hospital stay, treatment costs, and complication rates and improve patient quality of
life. These interventions also provide an opportunity for future investigations to improve outcomes in head
and neck microvascular surgery.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception of the study, performed literature analysis, and
interpretation, and contributed to the manuscript writing process: Gidumal S, Worrall D, Tanella A, Phan
N
Made substantial contributions to the conception of the study, contributed to the manuscript writing
process, and provided administrative, technical, and material support: DeMaria S, Miles B

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
All figures are original. The authors give consent for publication.