Post-Operative Care for Head and Neck Oral Cancer Surgery

Critical Airway Assessment

• In patients with tracheostomy, assess capping trials, adequacy of pulmonary toilet, and readiness for decannulation 1

Wound and Flap Evaluation

• Assess flap color, temperature, capillary refill, and turgor to detect early vascular compromise—free flap failure typically occurs within the first 72 hours and requires immediate surgical exploration 2
• Examine for wound dehiscence, particularly anterior intra-oral incisions, as this represents a serious complication requiring close monitoring due to risk of spreading infection 1

Drain Management

• Record drain output volume, color, and character for each drain separately—sudden increases may indicate bleeding or seroma formation 1
• Monitor for chyle leak in patients who underwent neck dissection, characterized by milky white drainage that increases with oral intake 1

Infection Surveillance

• Check for fever, tachycardia, and leukocytosis as indicators of surgical site infection requiring antibiotic adjustment 1
• Head and neck cancer patients are at higher risk for wound complications due to prior radiation therapy, compromised tissue vascularity, and proximity to oral flora 1

Functional Assessment

• Evaluate swallowing function and aspiration risk through bedside swallow assessment before advancing diet, as dysphagia affects both nutrition and aspiration pneumonia risk 1

Mobility and Complications Prevention

• Ensure early mobilization to prevent venous thromboembolism, pneumonia, and deconditioning 1

Discharge Planning Considerations

• Patients should be afebrile for 24 hours after stopping IV antibiotics before discharge is considered 1
• Drainage should have significantly decreased or resolved prior to drain removal and discharge 1

Common Pitfalls to Avoid

• Do not attribute all fever to expected post-operative inflammation—persistent fever beyond 48 hours warrants investigation for infection or other complications 1
• Do not delay intervention for flap compromise—salvage rates decrease dramatically after 6 hours of ischemia 2