Amit Kocchar, MD 

Head & Neck/Free Flap Surgeon

Phone: (305) 710-1130

General overview of cases:

 

  1. Operative time: 7-8 hours

  2. EBL: 800-1800cc

  3. Crystalloid: 2-3L

  4. Albumin: 1-1.5L

  5. Transfusion: HGB Goal 9 (USC Protocol, National recommendation is HCT of 25)

  6. Lines: Arterial, 2 peripheral IV, Central line is rare but defer to Anesthesiologist preference

  7. Paralysis – None

  8. Pressors – avoid If possible, no pressors at all when surgeon is under microscope. 

  9. Dispo: ICU

 

Anticipated surgical cases:

 

1.  Oral cavity carcinoma (Tongue, lip, buccal mucosa, palate)

Procedure: Hemiglossectomy or Wide local excision of tumor with neck dissection and Radial forearm free flap reconstruction

i.Difficult airway – possible

ii.Tracheostomy – Yes (awake if needed)

iii.Mandibulotomy – unlikely

iv.G tube – likely 

v.Duration: 7 hours 

 

2.  Oral cavity carcinoma with Mandibular invasion

Procedure: Composite resection of soft tissue with portion of mandible, with neck dissection and Fibula free flap reconstruction

i.Positioning: Supine

ii.Difficult airway – possible if there is significant trismus

iii.Tracheostomy – Yes (awake if needed)

iv.Mandibulectomy – yes 

v.G tube – likely 

vi.Duration: 8 hours

 

3.  Laryngeal/pharyngeal carcinoma (hypopharynx, larynx)

Procedure: Total laryngopharyngectomy with bilateral neck dissection, and Radial forearm free flap reconstruction

i.Difficult airway – likely 

ii.Tracheostomy – Yes (awake if needed) but will convert to laryngectomy stoma at end of surgery (Neck breather only)

iii.Mandibulotomy – unlikely

iv.G tube – likely 

v.Duration: 8 hours 

 

4. Parotid malignancy with facial nerve involvement

Procedure: Radical parotidectomy, neck dissection with and Anterolateral thigh free flap reconstruction

i.Positioning: Supine

ii.Difficult airway – unlikely 

iii.Tracheostomy – No 

iv.Mandibulectomy – No 

v.G tube – No 

vi.Duration: 8 hours

 

5.  Skin cancer resection of face

Procedure: Wide local excision of lesion with radial forearm free flap or Anterolateral thigh free flap reconstruction

i.Positioning: Supine

ii.Difficult airway – Unlikely 

iii.Tracheostomy – No 

iv.Mandibulectomy – No 

v.G tube – No 

vi.Duration: 6 hours

 

6.  Skin cancer resection of scalp (*May also involve neurosurgery)

Procedure: Wide local excision of lesion with radial forearm free flap, Anterolateral thigh free flap reconstruction, or Latissimus Dorsi Flap

i.Positioning: Supine or Lateral decubitous (only for latissimus flap)

ii.Difficult airway – Unlikely 

iii.Tracheostomy – No 

iv.Mandibulectomy – No 

v.G tube – No 

vi.Duration: 6 hours