Annals of plastic surgery
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Intraoperative management of hemodynamic instability during microvascular flap reconstruction is often based on anecdotal experience. Randomized controlled trials are difficult to perform when overall success rates are high. This study seeks to determine current practices for management of intraoperative hypotension during microsurgical free tissue transfer. ⋯ A national survey of microsurgeons demonstrates that many would not use vasopressors to treat intraoperative hypotension regardless of their experience. Although subject to responder bias, this report, nevertheless, outlines current practice. The need to develop a scientific basis for these practices is evident.
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Annals of plastic surgery · Jan 2014
Predictive risk factors of venous thromboembolism in autologous breast reconstruction surgery.
Venous thromboembolism (VTE) can be a significant cause of morbidity and mortality in autologous breast reconstruction surgery. The aim of this study was to evaluate the effect of patient characteristics, comorbidities, payer type, reconstruction type, reconstruction timing, radiation, chemotherapy, and teaching status of hospital on VTE (deep venous thrombosis and/or pulmonary embolism) in autologous breast reconstructive surgery. ⋯ In patients undergoing autologous breast reconstruction surgery, immediate reconstruction, older than 65 years, obesity, history of chemotherapy, and chronic lung disease are all independent predictors of higher VTE. Surgeons should consider these factors and use appropriate prophylaxis to minimize the risk of VTE development.