No abstract

Objectives Although there are many reports about risk factors for

Microvascular free tissue transfer is a reliable technique for head and neck reconstruction with success rates of 90–99%. Currently, there is no consensus concerning antithrombotic agents, antibiotics, or monitoring techniques. Therefore, the aim of this study was to review current literature dealing with microvascular free‐tissue transfer and factors influencing the outcome. In addition to excellent microsurgical techniques, coupling devices are a promising new technique, but are not useful in all arteries. Antibiotics should be given in three doses, as a more lengthy dosage time seems to have no advantage. The risk for elderly patients can be best assessed by the American Society of Anesthesiologists (ASA) score, but early mobilization, including intense chest physiotherapy, is important. Anticoagulation can be considered in cases of small vessels, significant size mismatch, vein graft, or vessels of poor quality. Monitoring should be done hourly during the first 24 hours and then every 4 hours for the next 2 postoperative days. © 2010 Wiley‐Liss, Inc. Microsurgery, 2010.

BACKGROUND: Hypofibrinogenaemia is one of the main reasons for development of perioperative coagulopathy during major paediatric surgery. The aim of this study was to assess whether prophylactic maintenance of higher fibrinogen concentrations through administration of fibrinogen concentrate would decrease the volume of transfused red blood cell (RBCs). METHODS: In this prospective, randomised, clinical trial, patients aged 6 months to 17 yr undergoing craniosynostosis and scoliosis surgery received fibrinogen concentrate (30 mg kg(-1)) at two predefined intraoperative fibrinogen concentrations [ROTEM(®) FIBTEM maximum clot firmness (MCF) of <8 mm (conventional) or <13 mm (early substitution)]. Total volume of transfused RBCs was recorded over 24 h after start of surgery. RE-SULTS: Thirty children who underwent craniosynostosis surgery and 19 children who underwent scoliosis surgery were treated per protocol. During craniosynostosis surgery, children in the early substitution group received significantly less RBCs (median, 28 ml kg(-1); IQR, 21 to 50 ml kg(-1)) compared with the conventional fibrinogen trigger of <8 mm (median, 56 ml kg(-1); IQR, 28 to 62 ml kg(-1)) (P=0.03). Calculated blood loss as per cent of estimated total blood volume decreased from a median of 160% (IQR, to a median of 90% (IQR, 78-110%) (P=0.017). No significant changes were observed in the scoliosis surgery population. No bleeding events requiring surgical intervention, postoperative transfusions of RBCs, or treatment-related adverse events were observed. CONCLUSIONS: Intraoperative administration of fibrinogen concentrate using a FIBTEM MCF trigger level of <13 mm can be successfully used to significantly decrease bleeding, and transfusion requirements in the setting of craniosynostosis surgery, but not scoliosis. CLINICAL TRIAL REGISTRY NUMBER: ClinicalTrials.gov NCT01487837. AbstractBackground: Hypofibrinogenaemia is one of the main reasons for development of perioperative coagulopathy during major paediatric surgery. The aim of this study was to assess whether prophylactic maintenance of higher fibrinogen concentrations through administration of fibrinogen concentrate would decrease the volume of transfused red blood cell (RBCs). Methods: In this prospective, randomised, clinical trial, patients aged 6 months to 17 yr undergoing craniosynostosis and scoliosis surgery received fibrinogen concentrate (30 mg kg

PurposeIn the modern anthropometry of complex structures, such as the face, different technical approaches for three-dimensional (3D) data acquisition have become increasingly more common. Results of meticulous evaluations have demonstrated a high level of precision and accuracy under both ideal and clinical circumstances.However, the question remains regarding which level of accuracy is adequate to meet clinical needs. Aside from the measuring technique itself, potential sources of error need to be identified and addressed. Involuntary facial movements in the subjects potentially influence clinical reliability. Materials and Methods The 3dMDfaceTM system was used in a clinical setting to investigate the influence of involuntary facial movements. Other factors of influence were systematically excluded. The mean technical error of the system (0.09 mm) was investigated in a previous study and taken into account for interpretation of the data. ResultsThe handling of the system was unproblematic for both data acquisition and data analysis. Including technical error and the influence of involuntary facial movements, the mean global error was 0.41 mm, with a range from 0.00 mm to 3.30 mm. Taking into account the technical error of the system known from the previous study, involuntary facial movements account for a mean error of 0.32 mm. ConclusionsThis range of involuntary facial movements clearly exceeds the known technical error of the utilized 3D photographic system. Given this finding, future 2 research should shift its focus from the analysis of the technical aspects of such systems to other influencing factors.