Awake microsurgery approach used for free flap reconstruction in frail patients

A retrospective cohort study of 40 patients compared general anesthesia (GA) with an Awake Integrated Microsurgical (AIM) approach using loco-regional anesthesia and sedation for head and neck free flap reconstruction after oncological resection. The authors report that AIM patients were older with higher comorbidity burden, yet all AIM procedures were completed without conversion to GA, operative time was shorter, no AIM patient required ICU admission, and rates of major complications and flap loss were similar between groups. The authors state these findings may help expand the role of awake microsurgery to selected low-risk patients within ERAS protocols.

Most relevant for: Elderly or medically frail patients requiring head and neck free flap reconstruction after oncological resection who may be considered unfit for general anesthesia.

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