Experimental prevention of free flap thrombosis. II: Normovolemic hemodilution for thrombosis prevention

Atchabahian, Arthur; Masquelet, A. C.

doi:10.1002/(sici)1098-2752(1996)17:12<714::aid-micr10>3.0.co;2-x

Cited by 20 publications

(10 citation statements)

References 23 publications

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“…On the other hand, it could improve oxygenation because of increased microcirculatory blood flow. In experimental studies, normovolaemic haemodilution reduces risk of thrombosis [13] and increases flap oxygenation [14]. In clinical studies, the debate of deliberate fluid therapy versus restrictive fluid therapy is still ongoing [15, 16], although a recent review favours restrictive fluid therapy [3].…”

Section: Discussionmentioning

confidence: 99%

Perioperative fluid overload increases anastomosis thrombosis in the free TRAM flap used for breast reconstruction

Booi

2010

Eur J Plast Surg

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To increase perfusion pressure with vasoactive drugs may be in conflict with the opinion of the reconstructive surgeon who maintains that the systemic administration of vasoactive agents causes vasoconstriction of the pedicle artery and the microvasculature. In free flap surgery, deliberate fluid therapy is used with a minimum of vasoactive drugs. This retrospective study was performed to analyse the perioperative fluid therapy, its effect on hemodynamic parameters and on the outcome of free flap surgery. One hundred and four patients were included in this retrospective study. The muscle sparing free transverse rectus abdominis myocutaneous flap was used for breast reconstruction. Perioperative hemodynamic data was used for this study. Twenty-seven patients had one or two complications requiring return to the operating room (OR). Two cases returned to the OR because of postoperative bleeding; in 11 patients, the anastomosis was revised. The reason for surgery in the latter group was venous stasis, due to thrombus formation at the venous anastomosis. The volume of fluid therapy was significantly higher in patients who returned to the OR due to thrombus formation at the anastomosis. Based on the results of this study, restricted intravenous fluid therapy or guided fluid therapy is recommended. Invasive monitoring such as central venous pressure and invasive arterial monitoring is recommended. Fluid loss should be replaced, and fluid overload should be avoided when the breast is reconstructed using free-tissue transfers.

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Section: Discussionmentioning

confidence: 99%

Perioperative fluid overload increases anastomosis thrombosis in the free TRAM flap used for breast reconstruction

Booi

2010

Eur J Plast Surg

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“…21 Atchabahian and Masquelet replaced 20% of the experimental group's blood with a hydroxyethyl starch solution. 26 In both studies, the experimental groups suffered a lower incidence of flap failure. Similarly, Earle et al found that flap survival length was increased in dogs that were preoperatively rendered anemic by replacement of some blood with lactated Ringer's solution.…”

Section: Discussionmentioning

confidence: 97%

Anemia is not a predictor of free flap failure: A review of NSQIP data

et al. 2013

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Background Thrombosis is a common cause of flap failure in microvascular tissue transfer, which questions the effects of anemia on this outcome. This article seeks to contribute a large, multi‐institutional data analysis to this debate. Methods Free tissue transfer patients were identified in the National Surgical Quality Improvement database through a specified Current Procedural Terminology algorithm. Bivariate analysis compared anemic and nonanemic groups with respect to flap failure and other outcomes. Multivariable logistic regression was used to determine risk factors for flap failure. Results Of the 864 patients who met inclusion criteria, 244 were anemic and 620 were not. Bivariate analysis showed no significant difference between groups with respect to flap failure (3.28% vs. 4.03%, P = 0.0603). Multivariate regression analysis supported this (OR 95% CI = 0.371–1.912). Conclusions These findings, based on the largest sample in the literature, show anemia is neither a predictor of free tissue transfer failure nor is it protective. © 2013 Wiley Periodicals, Inc. Microsurgery 33:432–438, 2013.

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“…Animal studies using HES (12), albumin (13) confirm the reduction in venous thrombosis by using this technique. SIGURDSSON (2) and CONRAD et al (14), studying pharmacologic optimization in microsurgery, recommended haemodilution (in particular with dextran 0,4 ml/kg/hour) as ideal thromboprophylaxis.…”

Section: Normovolaemic Haemodilutionmentioning

confidence: 99%

Thromboprophylaxis in Microsurgery

Lecoq¹,

Sénard²,

Hartstein³

et al. 2006

Acta Chirurgica Belgica

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Microsurgical free tissue transfer has become a gold standard in a wide range of clinical situations. Thrombosis at the anastomotic site is not only the most common cause of failure of microsurgical operations, but it is also one of the factors resulting in microcirculatory intravascular thrombosis in free flaps. All conditions of thrombus formation, defined by Virchow in 1856, are encountered in free flap surgery. This literature review concerns the problem of thromboprophylaxis in microsurgery. All citations published this last ten years (1996-2005) concerning this problem are noted. Data are confronted with other specialties, particularly vascular surgery, or with large retrospective studies. Protocol used in our institution is presented at the end of this lecture.

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Experimental prevention of free flap thrombosis. II: Normovolemic hemodilution for thrombosis prevention

Cited by 20 publications

References 23 publications

Perioperative fluid overload increases anastomosis thrombosis in the free TRAM flap used for breast reconstruction

Perioperative fluid overload increases anastomosis thrombosis in the free TRAM flap used for breast reconstruction

Anemia is not a predictor of free flap failure: A review of NSQIP data

Thromboprophylaxis in Microsurgery

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