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Objective: The objective of this study was to understand applicant perspectives on in‐person and virtual otolaryngology residency interviews. Study Design: Survey study. Setting: Otolaryngology residency applicants who were interviewed during 2022‐2023. Methods: Survey sent to all otolaryngology residency applicants who interviewed during the 2022‐2023 interview season. Results: A total of 499 applicants were surveyed with 150 responses (30%). Approximately 48.3% of respondents were offered an in‐person interview with 78.9% accepting the offer. Of those who did not accept, reasons included not wanting to travel (21.1%) and time conflicts (15.5%). When comparing virtual versus in‐person interviews, those who attended virtual interviews were more likely to disagree that they connected with residents (P =.02) and that they had an improved perspective of the program (P =.002). The majority of applicants agreed that virtual interviews are more inclusive and equitable than in‐person interviews (70.4%). When asked which interview style applicants would prefer, 63.1% of applicants preferred an in‐person interview when compared to virtual with a second look option (29.5%) and virtual (7.4%). Respondents who self‐identified as being underrepresented in medicine were less likely to choose in‐person as their preferred interview format (P =.01) and were more likely to decline an in‐person interview offer due to monetary limitations (P =.04). Conclusions: Applicants indicated dissatisfaction with connecting with residents and improving their perspective of the program when in a virtual setting. Applicants felt that virtual interviews were more equitable, but that if the barriers to equity were lessened then they would prefer in‐person interviews. [ABSTRACT FROM AUTHOR]

Background: Esophageal defects can result from primary pathologies such as malignancy or stricture, or secondary ones such as perforation due to trauma or iatrogenic injury. Techniques, management, and outcomes of reconstruction in this setting are poorly understood. Herein, we aim to highlight surgical outcomes in patients undergoing local and free flap reconstruction of esophageal defects in the setting of an intact larynx. Methods: Retrospective review of patients who underwent esophageal reconstruction with an intact larynx between 2009 and 2022 at our institution was performed. Results: Ten patients met inclusion criteria. Esophageal reconstruction was performed for extruded spinal hardware (n = 8), and esophageal stricture (n = 2). Four patients underwent reconstruction with free tissue transfer, and six with local pedicled flaps. There were no cases of flap failure, esophageal fistula, hematoma, or wound dehiscence. One patient had post‐operative bleeding requiring return to the operating room. Three patients had a postoperative wound infection, two of whom required washout. There were no unplanned 30‐day readmissions. At three months after operation, all patients who were not tube feed‐dependent prior to surgery returned to oral intake. Of the four patients who were tube feed‐dependent preoperatively, three were tolerating oral intake at nine months postoperatively. Nine patients (90%) had stable flexible laryngoscopy exams pre‐ and postoperatively with no voice changes. Conclusions: Reconstruction of esophageal defects in the setting of an intact larynx can be challenging. In this series, surgical intervention with free tissue transfer and local pedicled flaps was effective in returning patients to oral intake with low long‐term morbidity. Level of Evidence: 4 Laryngoscope, 134:1227–1233, 2024 [ABSTRACT FROM AUTHOR]

Objective: To identify practices in microvascular techniques in routine and challenging scenarios. Study Design: Cross‐sectional study. Methods: A national survey addressing practices related to microvascular free flap reconstruction was distributed to AHNS members between October and November 2021. Results: The respondents encompassed 95 microvascular surgeons. Median years of practice was 6 (interquartile range, 2–13) and median flaps per year was 35 (22–50). Common practices in arterial anastomosis included limited cleaning of artery (84.2%), use of a double approximating clamp (64.2%), and use of interrupted suture (88.4%). Common practices in venous anastomosis included limited cleaning (89.5%), downsizing the coupler (53.7%), and coupling to two independent venous systems (47.4%). In arterial anastomosis, respondents felt that kinking (50.5%) and tension (24.2%) were the riskiest challenges. Kinking was handled by loose sutures or native tissue/dissolvable biomaterial to orient pedicle. Excess tension was handled by additional dissection. With regards to associated practices, most surgeons perform anastomosis after partial inset (52.6%), give aspirin immediately postoperatively (66.3%), reserve transfusion for hemodynamic instability (69.5%), and utilize intraoperative pressors when needed (72.6%). More senior surgeons reported placing more suture to address leaks (p = 0.004) and perform end to side anastomosis on larger vein in case of venous mismatch (p = 0.012). In cases of tension, higher volume surgeons perform more extensive dissection (p = 0.035) and end to side coupling (p = 0.029). Conclusions: This survey of AHNS members indicates patterns of microvascular techniques in routine and challenging scenarios. There exists a variation in approaches amongst surgeons based on volume and practice length. Level of Evidence: 5 Laryngoscope, 134:1265–1277, 2024 [ABSTRACT FROM AUTHOR]