Oral Presentation Joint Scientific Meeting of the Australian & NZ Head & Neck Cancer Society & NZ Association of Plastic Surgeons

Evaluation of a streamlined head and neck service from conception to delivery of service with enhanced recovery regimes: a 12 months experience in Waikato  (1380)

Eric Tan 1 , Maria Mani 2 , James Sanders 3 , Abdul Ebrahim 3
  1. Plastic Surgery, Waikato DHB, Hamilton, Waikato, New Zealand
  2. Surgical Services, Plastic Surgery , Uppsala University, Uppsala, Sweden
  3. ENT, Waikato DHB, Hamilton, Waikato, New Zealand

Introduction: A new streamlined head and neck service (sHNS) was evaluated in Plastic Surgery, Waikato DHB to improve service delivery. We wish to share our learning experience and pitfalls in setting this combined service.


Methods: A detailed analysis of all head and neck procedures managed by the presenting author from August 2020.


Results: From August 2020, over a period of six months, 21 patients had free flaps combined with neck dissection, 10 patients had regional flap reconstruction combined with neck dissection and 9 with neck dissection alone.


Radial forearm and thigh flaps were our main reconstruction options of choice in addition to four functioning gracilis, 1 jejunal, 1 latissimus dorsi and 1 chimeric fibula flap. 


All flaps survived and 92% have more lymph nodes count than Sydney Melanoma Unit index. Our worst complication were bilateral pneumothoraces and pulmonary embolism on the same day of surgery (fibula flap).


29 out of 40 patients were over 70 years of age (73%). 12 reported significant pain/anxiety and 9 with significant weight/appetite loss at pre-operative stage.


All 40 patients were seen by members of a surgical pre-operative optimisation and post-surgical rehabilitation multidisciplinary team during first outpatient consultation. 22 patients over 70 years of age required immediate intervention pre-operatively.


Safeguards for robust flap monitoring in the ward remains our greatest challenge with 3 out of 4 patient requiring return to theatre for evacuation of haematoma at day 6 (1) and low threshold exploration (2). An enhanced recovery regime was developed to improve this deficit.


Post-operative protocols based on validated questionnaires identified 3 more patients for revision surgery and 2 for pain team referral.


Conclusion: Our 6 months data suggests sHNS improves patient care with holistic pre-operative and post-operative multidisciplinary approach. A 12 months data will be available by July for further evaluation.