Patient experience of flap monitoring following free flap surgery for oral cancer reconstruction

Regular free flap monitoring is an essential component of the post-operative management of patients following microvascular free tissue transfer (FTT). The frequency and duration of observation varies between units and there is no nationally agreed consensus. Best practice can be informed by patient feedback; however to patient perspectives of flap monitoring are absent from the literature. The aim of this study was to perform a cross-sectional survey of a consecutive group of patients following FTT to ascertain their experience of monitoring. A study specific questionnaire was used following consultation with the patient and carer forum. In the unit there were 150 patients treated by TFT in 2015 and 2016, of which 71% (106) responded to the survey. One quarter (28%) wanted more information about flap monitoring. Patients were generally not worried that much by the flap observations (86%); however one-third (32%) reported substantially disturbed sleep. Just over half (53%) were notably relieved when monitoring changed from hourly to every four hours, and almost all (98%) expressed a lack of worry about this changeover. Nearly half (45%) would have preferred less frequent observations whilst asleep. In conclusion, this perception could help inform a patient information leaflet on flap monitoring. Consideration could be given to reducing the frequency of monitoring, such as from 12- 6 am on night two the check at 1, 3 and 5 am could be omitted. This minor change could make a substantial difference for the patient but the impact of this on salvage needs to be audited.