How to Train a Head and Neck Reconstructive Surgeon? 张 陈 平 Chenping Zhang（MD,DDS,FRCS) Dept. of Oral & Maxillofacial – Head & Neck Oncology Shanghai Ninth People’s Hospital, Shanghai (200011) China

Oral & Maxillofacial – Head & Neck Oncology 180 inpatient-beds 4500 operations/year IAOMS Fellow Center AO Reference Center

“IAOMS” Fellow Center

Outline of training Didacties Fellow seminars-16, Attending seminars-15 Operating room experience 80 days Microvascular lab experience 4 days Tumor board Present at least one case per week Log book Complete record of minimum 50 patients from diagnosis to completion of treatment Log book of operation room experience Maintain dictated operation record of all cases performed

Fellow Training Course TYPE PERFORMED ASSISTED TOTAL Neck dissection 20 5 25 Bone Resection Salivary Glands 8 2 10 Soft Tissue Glands Local/Regional Flap Harvesting 15 Free Flap Harvesting Microvascular Anastomosis Craniofacial resection

History of our hospital 1952 found in Guang Ci Hospital（Ruijin Hospital） 1965 to Shanghai Ninth People’s Hospital

Academic Leaders Prof. ZHANG Xize(1911-2004) Prof. QIU Weiliu(1932- )

Chinese Flap Chinese flap was firstly applied by Prof.YANG Guofan in 1978

A total of 7923 Flaps From 1979 to 2011 All of these cases were collected from inpatient surgical record of Department of Oral Maxillofacial Surgery, Shanghai Ninth People’s Hospital, excluding off patients with congenital lip and palate cleft. Three phases were divided intentionally. From this picture, we can see an increasing trend of the number of reconstructive patients.

654 Free Flaps in 2011

The Survival Rate of Free Flaps Over 98% The successful rate of free flap transfer increased from 92% in 1980’s to 98.5% in 2000’s in our department.

Soft & Hard Defect in Head and Neck Tongue Buccal region Lip Soft palate Facial and neck skin Para-skull base Mandible Maxilla

The mandibular defect occupied the first position, 4 times higher than that of maxillary defect. It illustrated that the mandible was the most involved structure in oral maxillofacial region.

Goals of Reconstructive Surgery in Head and Neck Region Protection of vital structure Restoration of contour Restoration of function

Residents in our department Microsurgical work-shop: residents mainly mastered the reconstructive skills Clinical practice and improvement Strict management: by superior doctors and nurses in the ward, OT/ICU Clinical analysis and discussion: on complications monthly in whole department

End-to-end Anastomosis Suture for rubber sheet Exposure of rat A. Suture of rat tail A.

End-to-side Anastomosis

Criteria of Assessment 1 minute per suture 10 minute per vessel 30 minute completed V/A Clear and no leakage

Prince of Songkla University, Thailand

Malaysia, 2008

General Hospital Kuala Lumpur (GHKL), Malaysia

Acknowledgement

Thanks