Leyva-Vázquez LA, Cruz-Zermeño M, Seidman-Sorsby A, Telich-Tarriba JE, Cruz-Segura A

Language: Spanish
References: 18
Page: 46-49
PDF size: 255.99 Kb.

ABSTRACT

The administration of intraoperative intravenous solutions seeks to maintain tissue perfusion and the patient's hemodynamic stability. Despite its importance, the application of high volumes of intravenous fluids has been linked to the development of both systemic and local complications. However, in the current literature there is not enough information on this topic in the Mexican population. The objective of this work is to evaluate the impact of intraoperative intravenous fluid administration on the development of complications in patients undergoing microvascular flaps. A comparative, cross-sectional and retrospective study that included patients undergoing microsurgery was carried out in a reference center between 2015 and 2017. Demographic variables and postoperative outcomes, such as: necrosis, site infection, and systemic complications, among patients who experienced fluid overload during the transoperative period and those who did not experience it. 72 patients were included, 66% were women, with an average age of 47.03 ± 13.02 years. 78.3% of patients did not present complications, while 21% experienced some degree of necrosis. No significant association was found between fluid overload and the development of partial or total necrosis of the flap. Nevertheless, a relation was observed between hypervolemia and the development of systemic complications. We concluded that the fluid overload does not increase the risk of free flap loss, but it is connected to a greater risk of systemic complications. It is essential to adopt fluid resuscitation strategies that maintain optimal cardiac output and tissue perfusion, while limiting the development of interstitial edema.

REFERENCES

1. de la Garza G, Militsakh O, Panwar A, Galloway TL, Jorgensen JB, Ledgerwood LG et al. Obesity and perioperative complications in head and neck free tissue reconstruction. Head & Neck. 2016; 38 (Suppl 1): E1188-E1191.

2. Kuo YR, Jeng SF. Acute pulmonary edema after microsurgery: two case reports. J Reconstr Microsurg. 1998; 14 (2): 97-99.

3. Namdar T, Bartscher T, Stollwerck PL, Mailander P, Lange T. Complete free flap loss due to extensive hemodilution. Microsurgery. 2010; 30 (3): 214-217.

4. Motakef S, Mountziaris PM, Ismail K, Agag RL, Patel A. Emerging paradigms in perioperative management for microsurgical free tissue transfer: review of the literature and evidence-based guidelines. Plast Reconstr Surg. 2015; 135: 290-299.

5. Vincent A, Sawhney R, Ducic Y. Perioperative care of free flap patients. Semin Plast Surg. 2019; 33: 5-12.

6. Haddad-Tame JL, Chávez-Abraham V. Evolución de la microcirugía reconstructiva en el Servicio de Cirugía Plástica del Hospital General de México. Cir Plast. 2004; 14 (3): 159-170.

7. Bianchi B, Copelli C, Ferrari S et al. Free flaps: outcomes and complications in head and neck reconstruc-tions. J Craniomaxillofac Surg. 2009; 37: 438-442.

8. Odorico SK, Reuter Muñoz K, J Nicksic P, Gunderson KA, Wood K, H Nkana Z, Bond E, Poore SO. Surgical and demographic predictors of free flap salvage after takeback: a systematic review. Microsurgery. 2023; 43 (1): 78-88.

9. Copelli C, Tewfik K, Cassano L, Pederneschi N, Catanzaro S, Manfuso A et al. Management of free flap failure in head and neck surgery. Acta Otorhinolaryngol Ital. 2017; 37 (5): 387-392.

10. Sanati-Mehrizy P, Massenburg BB, Rozehnal JM, Ingargiola MJ, Hernandez-Rosa J, Taub PJ. Risk factors leading to free flap failure: analysis from the National Surgical Quality Improvement Program Database. J Craniofac Surg. 2016; 27 (8): 1956-1964.

11. Lese I, Biedermann R, Constantinescu M, Grobbelaar AO, Olariu R. Predicting risk factors that lead to free flap failure and vascular compromise: a single unit experience with 565 free tissue transfers. J Plast Reconstr Aesthet Surg. 2021; 74 (3): 512-522.

12. Moellhoff N, Broer PN, Heidekrueger PI, Ninkovic M, Ehrl D. Impact of intraoperative hypothermia on micro-surgical free flap reconstructions. J Reconstr Microsurg. 2021; 37 (2): 174-180.

13. Booi DI. Perioperative fluid overload increases anastomosis thrombosis in the free TRAM flap used for breast reconstruction. Eur J Plast Surg. 2011; 34 (2): 81-86.

14. Koc V, Delmas Benito L, de With E, Boerma EC. The effect of fluid overload on attributable morbidity after cardiac surgery: a retrospective study. Crit Care Res Pract. 2020; 2020: 4836862.

15. Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth. 2002; 89 (4): 622-32.

16. Polanco TO, Shamsunder MG, Hicks MEV, Seier KP, Tan KS, Oskar S et al. Goal-directed fluid therapy in autologous breast reconstruction results in less fluid and more vasopressor administration without outcome compromise. J Plast Reconstr Aesthet Surg. 2021; 74 (9): 2227-2236.

17. Sjoberg T, Numan A, de Weerd L. Liberal versus modified intraoperative fluid management in abdominal-flap breast reconstructions. A clinical study. Plast Reconstr Surg Glob Open. 2021; 9 (9): e3830.

18. Zhong T, Neinstein R, Massey C, McCluskey SA, Lipa J, Neligan P et al. Intravenous fluid infusion rate in microsurgical breast reconstruction: important lessons learned from 354 free flaps. Plast Reconstr Surg. 2011; 128 (6): 1153-1160.