Morgan Terry

Background: Intraoperative free flap failure necessitates prompt intraoperative decision‐making on alternative reconstructive strategies. In this study, we investigate the etiology and management of intraoperative flap loss. Methods: Retrospective review between 2010 and 2024 at 6 institutions. Results: There were 7423 free flaps performed with 46 instances of intraoperative flap failure (0.62%). The most common recipient subsite was oral cavity (27/46, 57%). Anterolateral thigh (ALT) was the most common flap type to fail (18/46, 39%), followed by the fibula (15/46, 32%). The most common reasons for total failure were clotting without observable vessel abnormality (12/35, 34.3%), poor quality perforator (11/35, 31.4%), and vessel spasm or intimal abnormality leading to clotting (8/35, 22.9%). The most common acute management was converting to an additional free flap intraoperatively (28/46, 60.9%). Conclusions: Flap failure intraoperatively is rare. The majority of cases were acutely managed with an additional flap to provide defect coverage.

Objective: Digital tools in healthcare are rapidly expanding, but access and readiness remain concerns. We assessed digital health access, interest, and factors associated with higher readiness using these tools among patients at a tertiary rhinology center. Study Design: Prospective study. Setting: Single, academic center. Methods: Patients presenting between February and October 2024 completed the Digital Health Readiness Questionnaire (DHRQ: range: 15‐75) to evaluate digital access, use, and motivation. Demographics and types of digital device use were collected. Multivariate linear regression, directed by manual stepwise forward selection and backwards elimination ( P < .100) procedures, was used to model independent predictors of high DHRQ scores. Results: A total of 100 subjects were included (mean age: 57.9 [±16.1 years]). Overall, 66% of subjects felt that learning digital skills could positively impact their health. Final adjusted modeling found that age was inversely associated with DHRQ scores (per 1‐year increase: β = −0.7; SE = 0.04; 95% CI: −0.2–0.01; P = .093), whereas daily smartphone use ( β = 10.5; SE = 2.3; 95% CI: 5.9–15.1; P < .001), wearable device use ( β = 7.3; SE = 1.5; 95% CI: 4.4–10.2; P < .001), daily computer/laptop use ( β = 4.8; SE = 1.6; 95% CI: 1.6–7.9; P = .004) and female sex ( β = 3.5; SE = 1.5; 95% CI: 0.9‐6.7; P = .011) were associated with greater digital health readiness (higher DHRQ scores). Conclusion: Subjects presenting to a tertiary rhinology center exhibited strong digital health interest, with female sex and greater technology engagement reflecting greater readiness to integrate these tools. Digital health literacy screening and targeted skills‐building may help close readiness gaps and facilitate integration of digital tools into care.

Background: Traumatic expanding intrathyroidal hematoma is rare and can be clinically obscured, leading to delayed diagnosis and potential airway compromise. Identification and prompt intervention are paramount to survival. Methods: Patient presented to the emergency department as a modified trauma without signs of respiratory distress or enlarging neck circumference. Comprehensive trauma imaging identified the thyroid pathology prompting otolaryngology involvement. Results: Rapid operating room arrangement allowed for prevention of airway compromise, straight forward intubation, and resolution of thyroid pathology prior to clinical decompensation. Conclusions: We present an unusual case of traumatic thyroid hematoma in which the bleeding source was contained within the thyroid capsule; intubation and surgical intervention resolved the airway and thyroid pathology. Trauma‐indicated imaging allowed for identification in a clinically obscured pathology.

Objective: To examine the impact of increased body mass index (BMI) on (1) tracheotomy timing and (2) short‐term surgical complications requiring a return to the operating room and 30‐day mortality utilizing data from the Multi‐Institutional Study on Tracheotomy (MIST).Methods: A retrospective analysis of patients from the MIST database who underwent surgical or percutaneous tracheotomy between 2013 and 2016 at eight institutions was completed. Unadjusted and adjusted logistic regression analyses were used to assess the impact of obesity on tracheotomy timing and complications.Results: Among the 3369 patients who underwent tracheotomy, 41.0% were obese and 21.6% were morbidly obese. BMI was associated with higher rates of prolonged intubation prior to tracheotomy accounting for comorbidities, indication for tracheotomy, institution, and type of tracheostomy (p = 0.001). Morbidly obese patients (BMI ≥35 kg/m²) experienced a longer duration of intubation compared with patients with a normal BMI (median days intubated [IQR 25%–75%]: 11.0 days [7–17 days] versus 9.0 days [5–14 days]; p < 0.001) but did not have statistically higher rates of return to the operating room within 30 days (p = 0.12) or mortality (p = 0.90) on multivariable analysis. This same finding of prolonged intubation was not seen in overweight, nonobese patients when compared with normal BMI patients (median days intubated [IQR 25%–75%]: 10.0 days [6–15 days] versus 10.0 days [6–15 days]; p = 0.36).Conclusion: BMI was associated with increased duration of intubation prior to tracheotomy. Although morbidly obese patients had a longer duration of intubation, there were no differences in return to the operating room or mortality within 30 days.Level of Evidence: 3 Laryngoscope, 134:4674–4681, 2024