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.