1. 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

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

3. “IAOMS” Fellow Center

4. 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

5. 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

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

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

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

9. 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.

10. 654 Free Flaps in 2011

11. 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.

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

13. 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.

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

15. 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

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

17. End-to-side Anastomosis

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

19. Prince of Songkla University, Thailand

20. Malaysia, 2008

21. General Hospital Kuala Lumpur (GHKL), Malaysia

22. Acknowledgement

23. Thanks