<abstract xmlns="http://www.w3.org/1999/xhtml"><p>Microvascular free flap surgery, has become an important part of reconstructive surgery during the last decades, as it allows closure of various tissue defects and recovery of organs function. Despite surgical progress resulting in high rates of transferred tissue survival, the risk of pedicle vessels thrombosis still remains a significant problem. A total of 108 articles from Pubmed and Science Direct databases published in 2005–2015 were analysed. This review of the literature assessed the influence of patient-dependent risk factors and different perioperative management strategies on development of microvascular free flap thrombosis. Sufficient evidence for risk associated with hypercoagulation, advanced age and certain comorbidities was identified. Presently, rotational thromboelastometry allows early hypercoagulability detection, significantly changing further patient management. Identification of flap thrombosis promoting surgery-related aspects is also essential in preoperative settings. Choice of anaesthesia and postoperative analgesia, administration of different types and amounts of fluids, blood products and vasoactive agents, temperature control are no less important in perioperative anaesthesiological management. More attention should be focused on timely preoperative evaluation of patient-dependent risk factors, which can influence anaesthesiological and surgical tactics during and after microvascular free flap surgery. Perioperative anaesthesiological management strategy continues to be controversial and therefore it should be performed based on thrombotic risk assessment and patient individual needs, thus improving flap survival rates and surgical outcome.</p></abstract>

Microvascular free flap surgery, has become an important part of reconstructive surgery during the last decades, as it allows closure of various tissue defects and recovery of organs function. Despite surgical progress resulting in high rates of transferred tissue survival, the risk of pedicle vessels thrombosis still remains a significant problem. A total of 108 articles from Pubmed and Science Direct databases published in 2005–2015 were analysed. This review of the literature assessed the influence of patient-dependent risk factors and different perioperative management strategies on development of microvascular free flap thrombosis. Sufficient evidence for risk associated with hypercoagulation, advanced age and certain comorbidities was identified. Presently, rotational thromboelastometry allows early hypercoagulability detection, significantly changing further patient management. Identification of flap thrombosis promoting surgery-related aspects is also essential in preoperative settings. Choice of anaesthesia and postoperative analgesia, administration of different types and amounts of fluids, blood products and vasoactive agents, temperature control are no less important in perioperative anaesthesiological management. More attention should be focused on timely preoperative evaluation of patient-dependent risk factors, which can influence anaesthesiological and surgical tactics during and after microvascular free flap surgery. Perioperative anaesthesiological management strategy continues to be controversial and therefore it should be performed based on thrombotic risk assessment and patient individual needs, thus improving flap survival rates and surgical outcome.

Factors Affecting the Risk of Free Flap Failure in Microvascular Surgery

Rīga Eastern Clinical University Hospital, Hipokrāta iela 2, Rīga, LV-1038,

Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, Rīga, LV-1002,

Department of Anaesthesiology and Reanimatology, Rīga Stradiņš University, Dzirciema iela 16, Rīga, LV-1007,

Latvian Biomedical Research and Study Centre, Rātsupītes iela 1, Rīga, LV-1067,

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

{"article-title":"Factors Affecting the Risk of Free Flap Failure in Microvascular Surgery"}

Microvascular free flap surgery, has become an important part of reconstructive surgery during the last decades, as it allows closure of various tissue defects...

Factors Affecting the Risk of Free Flap Failure in Microvascular Surgery

Published Online: Mar 01, 2017

Page range: 356 - 364

Received: Dec 09, 2015

DOI: https://doi.org/10.1515/prolas-2016-0039

Keywords
reconstructive surgery, free tissue transfer, free flap failure, anaesthesia

© 2016 Jevgeņijs Stepanovs et al., published by De Gruyter Open

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Factors Affecting the Risk of Free Flap Failure in Microvascular Surgery

Published Online: Mar 01, 2017

Page range: 356 - 364

Received: Dec 09, 2015

DOI: https://doi.org/10.1515/prolas-2016-0039

Keywordsreconstructive surgery, free tissue transfer, free flap failure, anaesthesia

© 2016 Jevgeņijs Stepanovs et al., published by De Gruyter Open

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Keywords
reconstructive surgery, free tissue transfer, free flap failure, anaesthesia