# Enhanced recovery after major head and neck cancer surgery with free flap reconstruction

Source: https://onco.cc/protocols/enhanced-recovery-after-head-and-neck-free-flap-surgery/  
OnCo record `enhanced-recovery-after-head-and-neck-free-flap-surgery` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Enhanced recovery after major head and neck cancer surgery means a short fast with a sugary drink, clot prevention, antibiotics, anti-sickness medicine, pain relief that spares opioids, careful fluids, frequent checks on the flap, getting up early, nutrition starting within a day of the operation, and a dietitian and speech and swallowing therapist from before surgery.

## Summary

The ERAS Society consensus review (2017; 17 topic areas, GRADE) is the only specialty guideline; only its abstract could be read, which names the best-practice elements without grades: preoperative carbohydrate treatment and no prolonged fasting, pharmacological thromboprophylaxis, perioperative antibiotics for clean-contaminated procedures, corticosteroid and antiemetic medicines, short-acting anxiolytics, goal-directed fluids, opioid-sparing multimodal analgesia, frequent flap monitoring and early mobilisation. The nutrition part is graded in full by ASPEN (2026): screen everyone for malnutrition with a validated tool (very low or expert opinion, strong); comprehensive dietitian assessment for those at risk (very low, strong); protein 1.2 to 1.5 g/kg a day (very low, strong) and energy at least 30 kcal/kg a day (high, strong); dietitian input before and after surgery for as long as nutrition is at risk (very low, strong); postoperative nutrition within 24 hours (very low, weak); a speech pathologist before treatment likely to affect swallowing (moderate, strong); an interdisciplinary nutrition team (moderate, strong); the choice of gastrostomy or nasogastric tube made by the team (moderate, weak).

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: ERAS head and neck; enhanced recovery free flap; perioperative care for head and neck cancer surgery; fast-track head and neck surgery

## Connected records

- protocols: [Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations](https://onco.cc/protocols/vte-prophylaxis-after-cancer-surgery/), [Oral care and oral mucositis prevention during cancer treatment](https://onco.cc/protocols/oral-mucositis-prevention-and-oral-care/), [Routine tests before planned surgery, by size of operation and fitness](https://onco.cc/protocols/routine-preoperative-tests/), [Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care](https://onco.cc/protocols/surgical-site-infection-prevention/)
- cancers: [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [Oral cavity cancer (mouth and tongue)](https://onco.cc/cancers/oral-cavity-cancer/)
- technologies: [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/), [Enteral and parenteral nutrition support](https://onco.cc/technologies/enteral-parenteral-nutrition/)
- ideas: [Enhanced recovery after cancer surgery, with each element's compliance measured and fed back](https://onco.cc/ideas/idea-pu-enhanced-recovery-with-measured-compliance/)

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