Microsurgery
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Postoperative nausea and vomiting (PONV) are commonly feared after general anesthesia and can impact results. The primary aim of our study was to examine incidence and severity of PONV by investigating complete response, or absence of PONV, to prophylaxis used in patients undergoing DIEP flaps. Our secondary aims were definition of the magnitude of risk, state of the art of interventions, clinical sequelae of PONV, and interaction between these variables, specifically for DIEP patients. ⋯ We identify previously undocumented high risks for PONV in DIEP patients. High frequency, severity, and refractoriness of PONV occur despite standard prophylaxis. Plastic surgeons and anesthesiologists should further investigate methods to optimize PONV prophylaxis and treatment in DIEP flap patients.
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Postoperative vascular compromise is a common but critical complication requiring emergent re-exploration, and remains a chief cause of free flap failure. This study investigated the relationship between postanesthetic shivering (PAS) and the development of postoperative complications associated with free flap reconstruction. One hundred thirty-six patients who underwent head and neck cancer resection and free flap reconstruction were retrospectively enrolled. ⋯ The dose of meperidine was positively correlated with PAS prevention in our statistical ROC curve analysis. The minimum effective dose of meperidine for PAS prevention was 0.35 mg/kg with 75% sensitivity and 60% specificity. These findings indicate that an optimal dose of meperidine could prevent PAS, which is shown to be associated with a decrease in the incidence of the early post-surgical re-exploration rate of these free flaps related to circulatory compromise.
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Extensive wounds about the knee can rarely be covered with local or even regional flaps. Free flaps often then become obligatory. Many factors will determine the surgeon's selection of the best donor site. ⋯ The deep inferior epigastric artery perforator (DIEAP) flap would therefore not usually be the donor site of choice from the surgeon's perspective. However, the opportunity to have a concomitant abdominoplasty that would improve body image or result in a scar readily hidden by clothing is an enticement for the patient not to be dismissed, under what normally are otherwise depressing circumstances. Over the past decade, three female patients have chosen the DIEAP free flap solely for the latter reasons, fully realizing that later flap revision would be needed to improve the function and appearance at the recipient site.