Outpatient Care
At our institution, preoperative assessments for free flap
reconstruction have been largely transitioned to telemedicine video
conferencing. The visit is coordinated by the clinical staff and the
patient is able to virtually interact with the provider using a
smartphone or tablet with video capabilities. This is all integrated
into the “MyUPMC” application that is a free online health portal
available to all of our patients.
While convenient in many ways for patients, the limitation with theses
visits is the inability to perform a comprehensive physical exam.
Vascular assessments, such as palpating lower extremity pulses and
Allen’s testing, are particular deficiencies. Nevertheless, we have
found that the ability to select an appropriate donor site and plan
accordingly remains intact. The availability of radiographic vascular
assessment (CT Angiogram), particularly for fibula free tissue transfer,
permits this. The quality of the video visits permits general assessment
of tumor size and the anticipated defect, facial nerve functionality,
and upper/lower extremity anatomy and function. Discussion with the
surgical oncologist, who has performed an in person assessment, further
allows appropriate planning. In cases in which a physical exam is
essential for planning, that is performed in the preoperative holding
area. We are careful to counsel patients that, based on this exam, the
reconstructive plan may change.
Postoperative visits have been conducted in person due to the need for
wound care, tracheostomy care, and flap assessment. We have attempted to
reduce the frequency of postoperative visits when feasible.
Postoperative assessments have been performed with personal protective
equipment (PPE) to include a standard surgical mask and eye protection.
Any aerosolizing procedure is performed with an N95 mask.