Microvascular Free Flaps and Major Head, Neck & Extremity Reconstructive Surgery — WACS Viva & Clinical Scenarios (Plastics & Dental)

Exam-style microvascular free flaps and major head, neck & extremity reconstructive surgery viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 48-year-old male is scheduled for a composite resection of a floor-of-mouth squamous cell carcinoma, modified radical neck dissection, and an immediate radial forearm microvascular free flap reconstruction. The surgery is anticipated to last 9 hours. Outline your complete anaesthetic management plan, focusing on invasive monitoring, target hemodynamic goals, fluid management strategy, and prevention of microvascular vasospasm.
• SCENARIO 2: During the 7th hour of a fibula osteocutaneous free flap reconstruction for mandibular defect in a 35-year-old female, the microvascular surgeon notes sluggish arterial inflow and sudden venous thrombosis at the micro-anastomosis site. Blood pressure is 85/50 mmHg, heart rate is 105 bpm, core temperature is 35.1°C, and haematocrit is 42%. How do you systematically troubleshoot and medically manage this flap failure crisis from the anaesthetic perspective?
• SCENARIO 3: A 24-year-old male who sustained a Gustilo-Anderson Grade IIIB tibial fracture in a motorcycle collision 3 weeks ago presents for soft tissue coverage with an anterolateral thigh (ALT) free flap. He has been bedridden and received multiple blood transfusions. Discuss your preoperative risk assessment, strategy for regional versus general anaesthesia, intraoperative rheological optimization, and postoperative multimodal analgesia.
• SCENARIO 4: A 56-year-old hypertensive female is undergoing a unilateral Deep Inferior Epigastric Perforator (DIEP) flap for breast reconstruction. The surgical team insists that no vasopressor be used under any circumstance during the entire case and demands high-volume fluid loading to maintain blood pressure. Critically appraise this request based on contemporary microvascular physiology and outline your evidence-based anaesthetic stance.