OTOLARYNGOLOGY RESIDENT SUPRACLAVICULAR, SUBMENTAL, AND OTHER REGIONAL FLAP EXPOSURE IN THE UNITED STATES

Presentation: B001
Topic: Clinical Research
Type: Poster
Date:
Session:
Authors: Andrew T Day, MD1, Liyang Tang, BS1, Jeremy D Richmon, MD2, Urjeet A Patel, MD3, Kevin S Emerick, MD2
Institution(s): 1Johns Hopkins Medical Institutions, 2Massachusetts Eye and Ear Infirmary, 3Northwestern University

Importance: The field of head and neck reconstruction has experienced a resurgence in the use of regional flaps with the recent introduction of supraclavicular and submental flaps.  However, the degree of resident exposure to these and other regional flaps is unknown.

Objective: To characterize otolaryngology resident exposure to supraclavicular, submental, and other regional flaps nationally

Setting: Online survey

Participants: Otolaryngology residents in the United States (US)

Exposure: An online survey was disseminated every two weeks to 106 US otolaryngology residency program directors for distribution within their programs between 8/31/16-10/14/16. Among an estimated 1520 otolaryngology residents, complete, adequate, and partial responses were obtained from 100, 106, and 121 residents, respectively. 

Results: Among the 106 residents with adequate responses, 52 (49.1 %) were PGY 1-3 residents and 54 (50.9 %) were PGY 4-7 residents.  Among PGY 4-7 residents, ever-exposure to pectoralis major flaps (n=53, 98.2%) was similar to radial forearm free flaps (n=54, 100%) but more than supraclavicular and submental flaps, respectively (n=32, 59.3%, p < 0.001; n=19, 35.3%, p < 0.001).  Similarly, PGY 4-7 ever-exposure to pectoralis major flaps was similar to paramedian forehead flaps but more than all other regional flaps (p < 0.01).  Residents in large programs (3-5 residents/year) were exposed to more supraclavicular and anterolateral thigh free flaps than residents in small programs (1-2 residents/year) [p = 0.04, p < 0.01].  A greater proportion of residents judged pectoralis major and radial forearm flaps as “very successful” (63/98, 64.2%; 67/103, 65.0%) compared to supraclavicular and submental flaps (5/46, 11.9%, p < 0.001; 7/28, 25%, p < 0.01).  

Conclusions: Fewer senior otolaryngology residents reported exposure to supraclavicular, submental, and most other regional flaps compared to pectoralis major flaps.  Supplemental regional flap training may be considered to increase exposure.  Resident perception that supraclavicular and submental flaps were not as successful as pectoralis major or radial forearm flaps should be investigated further.