BackTable / ENT / Podcast / Episode #128
Free Flaps 101
with Dr. Eli Gordin
In this episode of BackTable ENT, Dr. Eli Gordin, microvascular surgeon at UT Southwestern, joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss free flap surgery. This high-yield episode walks listeners through the basics of microvascular surgery, from indications to management of surgical complications.
BackTable, LLC (Producer). (2023, September 12). Ep. 128 – Free Flaps 101 [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Eli Gordin
Dr. Eli Gordin is an otolaryngologist, head and neck surgeon, facial plastic surgeon, and assistant professor with the department of otolaryngology at UT Southwestern in Dallas, Texas.
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
First, the surgeons discuss pre-operative management of free flap patients. The most common indications for microvascular surgery in otolaryngology include head & neck cancers. In his pre-operative clinic visits with free flap patients, Eli answers questions about surgery, hospital stay, and recovery. In his experience, patients often don’t understand the extensive nature of these surgeries prior to this visit, so he spends time explaining what a flap is and what the hospital course will look like.
Then, Eli speaks about his experience with virtual surgical planning, which entails remote meetings with engineers. He admits that the learning curve to virtual surgical planning is steep, but that contemplating reconstruction with the help of virtual planning helps him better account for details at the time of surgery. Gopi and Ashley then inquire about surgery and peri-operative management of these patients. Eli addresses vital topics including surgical technique, fluid management, and thrombosis risk.
Finally, the podcast addresses post-operative management of free flap patients. Eli briefly outlines his free flap protocol, emphasizing physical exam signs that indicate need for an OR takeback. He leaves listeners with an important insight: when surgeons have any doubts regarding the viability of a flap, they must return to the OR quickly: the best look they can get at a troubled flap is the one obtained in the OR.
[Dr. Eli Gordin] If you think that there's a problem, you might as well just look and see, and then you'll feel better if you open up the neck and see that everything looks fine, then great. You have to force yourself to just do the right thing because it only gets harder the further along the timeline you get when bad things are happening. The last thing you want to have to do is then do a whole new flap. This applies to intraoperative situations too. I've had cases where you're doing, let's say a fibula, and then the skin paddle doesn't look good, but the bone looks fine, and you didn't find a nice skin perforator.
Now, it's seven o'clock at night and you're like, "Well, the skin paddle doesn't look right. Should I just close it up and see what happens or should I just now put a thigh flap on top of this and remove the skin and do a second flap?" At some point you learn that it's just easier to take care of things immediately, as soon as possible, and not hope that something that looks wrong is going to just right itself at some point in the future. That's probably the main thing.
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