Hi there,
This is my first post. My mother has been diagnosed with mouth cancer but thankfully surgery is an option. She will need one third of her lower jaw removed and reconstruction using a fibula free flap. It was an awful shock for her and us all but we got our heads around this new situation and while it is huge surgery we have great confidence in her ENT and plastics team.
However one thing came up in a recent meeting. The plastic surgeon told my mother that immediately after surgery she will have to spend 5 days in a well heated room. He described this as being the most challenging and tough part of the whole procedure. He explained that this will keep the newly connected blood vessels in the flap open and aid healing. He said the room will feel like a dry sauna, possibly over 30 degrees C.
This might sound crazy, but more than the description of the surgery, this frightened my mother and us the most. She cannot tolerate hot temperatures. Her whole life she could not stand hot environments or weather. It completely exhausts her and makes her physically ill. It may sound minor but I can't overstate this enough. Having been stoic about what is to come she is now going to pieces. This is a very strong woman, but this terrifies her.
I've done some reading about post-op recovery and I can't find anything anywhere about heated rooms. Is this a common method? The surgeon is absolutely insistent that this is a vital part of the success of the flap.
We do realise how tough and long the road ahead is and that this seems minor but her confidence is very shaken now and I thought I'd ask about it. Thanks in advance for any advice or insights folks.

***ADMIN NOTE ---- 30C is 86F ***

Welcome to OCF! Im very sorry you have a need for our group. Dont worry, we will do our best to assist you as much as possible.

Please understand our site is made up of fellow survivors/patients and caregivers. We do not have medical backgrounds or years of medical school and training. But we do have first hand knowledge of many procedures having been thru them ourselves.

Since Im in the US I have no info about how your medical system works or what is available, I can only talk about things in the US. Here, Ive had many surgeries (including 2 mandibulectomies) and I have not heard of the heated room after surgery being done. What Ive always understood, they purposely keep the temperature lower in the hospitals here to help keep the germs from spreading. (It sounds kinda silly when I type it, but this.) I wonder if this is a new procedure? In your country is it possible to seek out a second opinion? Are your mother physicians working together and consulting to create her treatment plan? Im sorry but I have not heard of the high room temp after surgery before. I cant remember of any of our members (over the past 9+ years) mentioning it either.

Hi Christine. Thanks so much for replying!
I don't get the impression this is a new procedure as such. After a good deal of research and now your reply here, I'm beginning to wonder if this isn't our surgeon's personal 'belt and braces' approach to try and ensure a successful flap. But it appears that success rates are normally very high anyway (well into the 90s percentile). Across the globe the procedure does seem to be the a well established one and all descriptions seem to be identical with the exception of this 'heated room' step. Her team (oncology, plastics, anesthetics and physio) do seem well linked up and I believe they work together frequently.
I appreciate you taking the time to reply and reading your medical bio above I'm in awe of your strength! Best wishes to you!

I just had this surgery in September with the fibular free flap, and agree with Christine that the OR and Rooms are kept cool here, and I usually need two or three blankets to keep warm. What I had was a smal humidifier over the trache for a few days, nasal tube. compressions stockings, various drains, foley and boot on the flap donor leg. They did check the jaw flap with a portable Doppler for blood flow hourly.

Good luck

Thank you PaulB. Good luck to you.

Redser7,

Welcome to the forum although I am also sorry that you have the need to be here.

If indeed your mother's treatment is as described, could you post more information, such as when she is in the room, the temperature in there and how long she was in there? ]it will help us and all those to come to learn a bit more about a procedure that we are not familiar with. I know it is difficult to post while you are looking after your mum, but whatever information you can give us when you can will be so very helpful. Thanks.

I'll be sure and do that gmcraft.

I found some information in regards to Anesthesia, Microsvascular flap surgery, and temperature:


Temperature

In addition to vasoconstriction, hypothermia is also responsible for increased viscosity and hematocrit, platelet and red blood cells aggregation, which can reduce the microcirculation in the flap. Thus, the patient should be kept warm in the operating room, ICU, and the first 24 to 48 hours. This can be achieved by increasing the room temperature and using forced air heater. Active heating should start before the onset of anesthesia, as the patient rapidly cools after induction6.

Warming

Intuitively, it makes sense to keep these normothermic patients with active warming to prevent increased viscosity and vasoconstriction. Normothermia maintenance may be difficult with large areas exposed for prolonged periods, associated with fluid and blood loss. Furthermore, anesthesia changes the thermoregulatory mechanisms.

In the '80s, some studies of animals have confirmed the deleterious effects of hypothermia on viscosity and flow of pedicle and free flaps20. There are few studies of the effects of hypothermia on flap blood flow in humans, perhaps because it may be unethical. However, there are reports of flaps that survived hypothermia associated with cardiac bypass 14.

Central and peripheral temperature must be monitored and the ideal difference (Δt) between them should be less than 1ºC. The (Δt) can reflect the volemic status of a patient4.

Active heating (solution heaters, blanket with forced hot air) should be initiated as soon as possible and cover the greatest possible extent. If possible, the room temperature must be increased to 22º-24ºC, a temperature that reduces heat loss from the patient and is not uncomfortable for the surgical team 6.

You can read the full article here:

http://www.scielo.br/pdf/rba/v62n4/en_v62n4a11.pdf

That's so helpful PaulB. Thanks for finding that and posting!