Serbest Doku Flebi Cerrahisinde Anestezi

Murat Türkeün Ilgınel

TR EN

Serbest Doku Flebi Cerrahisinde Anestezi

Öz

Serbest doku transferi, pedikül flebi veya lokal ilerleme flepleri ile kapatılamaya uygun olmayan daha büyük yumuşak doku defektlerinin kapatılması için önemli bir tekniktir. Vasküler pedikül boyunca kas veya fasya, üstteki cilt ile veya cilt olmadan kaldırılır ve vasküler anastomozlar ile transfer edilir. Flep yetmezliği bu cerrahiye ait büyük bir potansiyel komplikasyondur ve perioperatif anestezi yönetimi başarılı cerrahi için önemli bir unsurdur. Serbest flep operasyonu için anestezinin kılavuz ilkesi optimum kan akımının sürdürülmesidir. Ek olarak, serbest flep ameliyatı için anestezinin hedefleri vazodilatasyon, iyi perfüzyon basıncı ve düşük viskositedir. Bu nedenle, ağrı, hipotermi ve hipovolemi de dahil olmak üzere vazokonstriksiyona neden olabilecek faktörlerden kaçınılmalıdır.

Anahtar Kelimeler

Anestezi,mikrosirkülasyon,rekonstrükrif cerrahi,flep

Kaynakça

1- Mak HCY, Irwin MG. Anaesthesia for plastic and reconstructive surgery. Anaesthesia & Intensive Care Medicine. 2015;16:136-9.
2- McLean DH, Buncke HJ Jr. Autotransplant of omentum to a large scalp defect, with microsurgical revascularization. Plast Reconstr Surg. 1972;49(3):268–74.
3- Blackwell KE. Unsurpassed reliability of free flaps for head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1999;125:295–9.
4- Hidalgo DA, Jones CS. The role of emergent exploration in free-tissue transfer: a review of 150 consecutive cases. Plast Reconstr Surg. 1990;86:492–8.
5- Suh JD, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Alam D, et al. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg. 2004;130:962–6.
6- Khouri RK, Cooley BC, Kunselman AR, Landis JR, Yeremian P, Ingram D, et al. A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg. 1998;102(3):711–21.
7- Kroll SS, Schusterman MA, Reece GP, Miller MJ, Evans GR, Robb GL, et al. Choice of flap and incidence of free flap success. Plast Reconstr Surg. 1996;98(3):459–63.
8- Kakarala K, Emerick KS, Lin DT, Rocco JW, Deschler DG. Free flap reconstruction in 1999 and 2009: changing case characteristics and outcomes. Laryngoscope. 2012;122:2160–3.
9- Singh B, Cordeiro PG, Santamaria E, Shaha AR, Pfister DG, Shah JP. Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg. 1999;103:403-11.
10- Quinlan J. Anaesthesia for reconstrutive surgery. Anaesth Intensive Care. 2006;7:31-3.

11- Adams J, Charlton P. Anaesthesia for microvascular free tissue transfer. Bja Cepd Reviews. 2003;3:33-7.
12- Rosen MI, Manaker S. Oxygen delivery and consumption. Parson PE, Finlay G.(ed.), Uptodate. Erişim tarihi:15 Şubat 2018 Available from: https://www.uptodate.com/contents/oxygen-delivery-and-consumption
13- Pushparaj S, Boyce H, Chisholm D. Anesthetic consideration in a postchemotherapy pediatric patient for segmental mandibulectomy with free fibula reconstruction. Curr Anaesth Crit Care. 2009;20:18-21.
14- Segal SS. Regulation of blood flow in the microcirculation. Microcirculation. 2005;12:33-45.
15- Beausang ES, Ang EE, Lipa JE, Irish JC, Brown DH, Gullane PJ, et al. Microvascular free tissue transfer in elderly patients: the Toronto experience. Head Neck. 2003;25:549e53.
16- Miller RB, Reece G, Kroll SS, Chang D, langstein H, Ziogas A, et al. Microvascular breast reconstruction in the diabetic patient. Plast Reconstr Surg. 2007; 119: 38-45.
17- Reus WF, Colen LB, Straker DJ. Tobacco smoking and complications in elective microsurgery. Plast Reconstr Surg. 1992;89:490-4.
18- Padubidri AN, Yetman R, Browne E, Lucas A, Papay F, LariveB, et al. Complications of postmastectomy breast reconstructions in smokers, ex-smokers, and nonsmokers. Plast Reconstr Surg. 2001,107:342–9.
19- Kuri M, Nakagawa M, Tanaka H, Hasuo S, Kishi Y. Determination of the duration of preoperative smoking cessation to improve wound healing after head and neck surgery. Anesthesiology. 2005;102:892–6.
20- Scalia R, Gong Y, Berzins B, Zhao LJ, Sharma K. Hyperglycemia is a major deter- minant of albumin permeability in diabetic microcirculation. The role of l-Calpain. Diabetes. 2007;56:1842-9.
21- Chang DW, Wang B, Robb GL et al – Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg, 2000;105:1640- 1648.
22- Pereira CMB, Figuerido MEL, Carvalho R, Catre D, Assunção JP. Anesthesia and surgical microvascular flaps. Brazilian Journal of Anesthesiology. 2012;62:563-79.
23- Krassnitzer S. Anaesthesia for reconstructive surgery. Anaesthesia & Intensive Care Medicine. 2012;13:131-4.
24- Bruegger D, Bauer A, Finsterer U, Bernasconi P, Kreimeier U, Christ F. Microvascular changes during anesthesia: Sevo urane compared with propofol. Acta Anaesthesiol Scand. 2002;46:481–7.
25- Lucchinetti E, Zeisberger SM, Baruscotti I, Wacker J, Feng J, Zaugg K, et al. Stem cell-like human endothelial progenitors show enhanced colony-forming capacity after brief sevo urane exposure: Preconditioning of angiogenic cells by volatile anesthetics. Anesth Analg. 2009;109:1117–26.
26- Banic A, Krejci V, Erni D, Petersen-Felix S, Sigurdsson GH. Effects of extradural anesthesia on microcirculatory blood ow in free latissimus dorsi musculocutaneous aps in pigs. Plast Reconstr Surg. 1997;100:945–55; discussion 956.
27- Erni D, Banic A, Signer C, Sigurdsson GH. Effects of epi- dural anaesthesia on microcirculatory blood ow in free aps in patients under general anaesthesia. Eur J Anaesthesiol. 1999;16:692–8.
28- Cayci C, Cinar C, Yucel OA, Tekinay T, Ascherman JA. The effect of epidural anesthesia on muscle ap tolerance to venous ischemia. Plast Reconstr Surg. 2010;125:89–98.
29- Bozkurt M, Kulahci Y, Zor F, Sen H, Acıkel CH, Deveci M, et al. Comparison of the effects of inhalation, epidural, spinal, and combined anesthesia techniques on rat cremaster muscle ap microcirculation. Microsurgery. 2010;30:55–60.
30- Scott GR, Rothkopf DM, Walton RL. Eficacy of epidural anesthesia in free aps to the lower extremity. Plast Reconstr Surg. 1993;91:673–7.
31- Alam NH, Haeney JA, Platt AJ. Three episodes of gracilis free muscle transfer under epidural anaesthesia. J Plast Reconstr Aesthet Surg. 2006;59:1463–6.
32- Carey JN, Watt AJ, Ho O, Zeidler K, Lee GK. Free ap scalp reconstruction in a 91-year-old patient under local-regional anesthesia: Case report and review of the literature. J Reconstr Microsurg. 2012;28:189–93.
33- Kurt E, Ozturk S, Isik S, Zor F. Continuous brachial plexus blockade for digital replantations and toe-to-hand transfers. Ann Plast Surg. 2005;54:24–7.
34- Su HH, Lui PW, Yu CL, Lin C, Lin Y, Yang M, et al. The effects of continuous axil- lary brachial plexus block with ropivacaine infusion on skin temperature and survival of crushed ngers after microsurgical replantation. Chang Gung Med J. 2005;28:567–74.
35- Young VL, Watson ME. Prevention of perioperative hypothermia in plastic surgery. Aesthet Surg J. 2006;26:551–71.
36- Motakef S, Mountziaris PM, Ismail IK, Agag RL, Patel A. Emerging paradigms in perioperative management for microsurgical free tissue transfer: review of the literature and evidence-based guidelines. Plastic and reconstructive Surgery. 2015;135:290-9.
37- Gardiner MD, Nanchahal J. Strategies to ensure success of microvascular free tissue transfer. J Plast Reconstr Aesthet Surg. 2010;63:e665–73.
38- Hagau N, Longrois D. Anesthesia for free vascularized tissue transfer. Microsurgery. 2009;29:161–7.
39- Weinzweig N, Lukash F. Topical and systemic calcium channel blockers in the prevention and treatment of microvascular spasm in a rat epigastric island skin flap model. J Ann Plast Surg. 1999;42:320-6.
40- Vegas JMR, Alonso MER, Saavedra PPT. PGE-1 in replantation and free tissue transfer: early preliminary experience. Microsurgery. 2007;27:395-7.
41- Banic A, Krejci V, Erni D, Wheatley AM, Sigurdsson GH. Effects of sodium nitroprusside and phenylephrine on blood flow in free musculocutaneous flaps during general anesthesia. Anesthesiology. 1999;90:147-55.
42- Jones SJ, Scott DA, Watson R, Morrison WA. Milrinone does not improve free flap survival in microvascular surgery. Anaesth Intensive Care. 2007;35:720-5.
43- Cordeiro PG, Santamaria E, Hu QY, Heerdt P. Effects of vasoactive medications on the blood flow of island musculocutaneous flaps in swine. Ann Plast Surg. 1997;39:524–31.
44- Chen C, Nguyen MD, Bar-Meir E, Hess PA, Lin S, Tobias AM, et al. Effects of vasopressor administration on the outcomes of microsurgical breast reconstruction. Ann Plast Surg. 2010;65:28–31.
45- Monroe MM, McClelland J, Swide C, Wax MK. Vasopressor use in free tissue transfer surgery. Otolaryngol Head Neck Surg. 2010;142:169–73.
46- Monroe MM, Cannady SB, Ghanem TA, Swide CE, Wax MK. Safety of vasopressor use in head and neck microvascular reconstruction: A prospective observational study. Otolaryngol Head Neck Surg. 2011;144:877–82.
47- Kelly DA, Reynolds M, Crantford C, Pestana IA. Impact of intraoperative vasopressor use in free tissue transfer for head, neck, and extremity reconstruction. Ann Plast Surg. 2014;72:135–8.
48- Harris L, Goldstein D, Hofer S, Gilbert R. Impact of vasopressors on outcomes in head and neck free tissue transfer. Microsurgery. 2012;32:15–9.
49- Scholz A, Pugh S, Fardy M, Shafik M, Hall JE. The effect of dobutamine on blood flow of free tissue transfer flaps during head and neck reconstructive surgery. Anaesthesia. 2009;64:1089–93.
50- Suominen S, Svartling N, Silvasti M, Niemi T, Kuokkanen H, Asko-Seljavaara S. The effect of intravenous dopamine and dobutamine on blood circulation during a microvascular TRAM flap operation. Ann Plast Surg. 2004;53:425–31.
51- Eley KA, Young JD, Watt-Smith SR. Epinephrine, norepinephrine, dobutamine, and dopexamine effects on free flap skin blood flow. Plast Reconstr Surg. 2012;130:564–70.
52- Eley KA, Young JD, Watt-Smith SR. Power spectral analysis of the effects of epinephrine, norepinephrine, dobutamine and dopexamine on microcirculation following free tissue transfer. Microsurgery. 2013;33:275–81.
53- Karakida K, Aoki T, Ota Y, Yamazaki H, Otsuru M, Takahashi M, et al. Analysis of risk factors for surgical-site infections in 276 oral cancer surgeries with microvascular free-flap reconstructions at a single university hospital. J Infect Chemother. 2010;16:334–9.
54- Sigurdsson GH. Perioperative fluid management in microvascular surgery. J Reconstr Microsurg. 1995;11:57-65.
55- Zhong T, Neinstein R, Massey C, Mccluskey SA, Lipa J, Nelligan P, et al. Intravenous fluid infusion rate in microsurgical breast reconstruction: Important lessons learned from 354 free flaps. Plast Reconstr Surg. 2011;128:1153–60.
56- Clark JR, McCluskey SA, Hall F, Lipa J, Nelligan P, Brown D, et al. Predictors of morbidity following free flap reconstruction for cancer of the head and neck. Head Neck 2007;29:1090–101. 57- Haughey BH, Wilson E, Kluwe L, Piccirillo J, Fredrickson J, Sessions D, et al. Free flap reconstruction of the head and neck: Analysis of 241 cases. Otolaryngol Head Neck Surg. 2001;125:10–7.
58- Hill JB, Patel A, Del Corral GA, Sexton KW, Ehrenfeld JM, Guillamondegui OD, et al. Preoperative anemia predicts thrombosis and free flap failure in microvascular reconstruction. Ann Plast Surg. 2012;69:364–7.
59- Macdonald DJ. Anaesthesia for microvascular surgery: A physiological approach. Br J Anaesth. 1985;57:904–12.
60- Sigurdsson GH. Perioperative fluid management in microvascular surgery. J Reconstr Microsurg. 1995;11:57–65.
61- Sigurdsson GH, Thomson D. Anaesthesia and microvascular surgery: Clinical practice and research. Eur J Anaesthesiol. 1995;12:101–22.
62- Kim BD, Ver Halen JP, Mlodinow AS, Kim JY. Intraoperative transfusion of packed red blood cells in microvascular free tissue transfer patients: Assessment of 30-day morbidity using the NSQIP dataset. J Reconstr Microsurg. 2014;30:103–14.
63- Fischer JP, Nelson JA, Sieber B, Stransky C, Kovach S, Serletti JM, et al. Transfusions in autologous breast reconstructions: An analysis of risk factors, com- plications, and cost. Ann Plast Surg. 2014;72:566–71.
64- Szakmany T, Dodd M, Dempsey GA, Lowe D, Brown J, VAughan ED, et al. The influence of allogenic blood transfusion in patients having free-flap primary surgery for oral and oropharyngeal squamous cell carcinoma. Br J Cancer. 2006;94:647–53.
65- Woolley AL, Hogikyan ND, Gates GA, Haughey BH, Schechtman KB, Goldenberg JL. Effect of blood transfusion on recurrence of head and neck carcinoma: Retrospective review and meta-analysis. Ann Otol Rhinol Laryngol. 1992;101:724–30.
66- Jackson RM, Rice DH. Blood transfusions and recurrence in head and neck cancer. Ann Otol Rhinol Laryngol. 1989;98:171–3.
67- Jones KR, Weissler MC. Blood transfusion and other risk factors for recurrence of cancer of the head and neck. Arch Otolaryngol Head Neck Surg. 1990;116:304–9.
68- Vamvakas EC. Perioperative blood transfusion and cancer recurrence: Meta-analysis for explanation. Transfusion 1995;35:760–8.
69- Kao HK, Chang KP, Ching WC, Tsao CK, Cheng MH, Wei FC. Postoperative morbidity and mortality of head and neck cancers in patients with liver cirrhosis undergoing surgical resection followed by microsurgical free tissue transfer. Ann Surg Oncol. 2010;17:536–43.
70- Taniguchi Y, Okura M. Prognostic significance of perioperative blood transfusion in oral cavity squamous cell carcinoma. Head Neck. 2003;25:931–6.
71- Perisanidis C, Dettke M, Papadogeorgakis N, Schoppmann A, Mittlböck M, Kyzas PA, et al. Transfusion of allogenic leukocyte-depleted packed red blood cells is associ- ated with postoperative morbidity in patients undergoing oral and oropharyngeal cancer surgery. Oral Oncol. 2012;48:372–8.
72- Liu SA, Wong YK, Poon CK, Wang CC, Wang CP, Tung KC. Risk factors for wound infection after surgery in primary oral cavity cancer patients. Laryngoscope 2007;117:166–71.
73- Vamvakas EC, Blajchman MA. Transfusion-related immunomodulation (TRIM): An update. Blood Rev. 2007;21:327–48.
74- Moir MS, Samy RN, Hanasono MM, Terris DJ. Autologous and heterologous blood transfusion in head and neck cancer surgery. Arch Otolaryngol Head Neck Surg. 1999;125:864–8.
75- Louer CR, Chang JB, Hollenbeck ST, Zenn MR. Autologous blood use for free flap breast reconstruction: A comparative evaluation of a preoperative blood donation program. Ann Plast Surg. 2013;70:158–61.
76- Vega SJ, Nguyen TV, Forsberg C, HUa LB, Kirkley S, Herrera HR, et al. Efficacy of preoperative autologous blood donation in free TRAM flap breast reconstruction. Plast Reconstr Surg. 2008;121:241–6.
77- Chen CM, Ashjian P, Disa JJ, Cordeiro PG, Pusic AL, Mehrara BJ, et al. Is the use of intraoperative heparin safe? Plast Reconstr Surg. 2008;121:49-53.
78- Chien W, Varvares MA, Hadlock T, Chenet M, Deschler DG. Effects of aspirin and low dose heparin in head and neck reconstruction using microvascular free flaps. Laryngoscope. 2005;115:973-6.
79- Disa JJ, Polvora VP, Pusic AL, Singh B, Cordeiro PG. Dextran related complications in head and neck microsurgery: Do the benefits outweigh the risks? A prospective randomized analysis. Plast Reconstr Surg. 2003;112:1534–9.
80- Riva FM, Chen YC, Tan NC, Lin PY, Tsai YT, Chang HW, et al. The outcome of prostaglandin-E1 and dextran-40 compared to no antithrombotic therapy in head and neck free tissue transfer: Analysis of 1,351 cases in a single center. Microsurgery. 2012;32:339–43.
81- Ashjian P, Chen CM, Pusic A, Disa JJ, Cordeiro PG, Mehrara BJ. The effect of postoperative anticoagulation on microvascular thrombosis. Ann Plast Surg. 2007;59:36–40.
82- Lighthall JG, Cain R, Ghanem TA, Wax MK. Effect of post- operative aspirin on outcomes in microvascular free tissue transfer surgery. Otolaryngol Head Neck Surg. 2013;148:40–6.
83- Gerressen M, Pastaschek CI, Riediger D,Hillgers RD, Hölze F, Noroozi N, et al. Microsurgical free flap reconstructions of head and neck region in 406 cases: a 13-year experience. J Oral Maxillofac Surg. 2013;71:628–35.
84- Fosnot J, Jandali S, Low DW, Kovach SJ III, Wu LC, Serletti JM. Closer to an understanding of fate: The role of vascular complications in free flap breast reconstruction. Plast Reconstr Surg. 2011;128:835–43.
85- Khouri RK, Sherman R, Buncke HJ Jr, Feller AM, Hovius S, Benes CO, et al. A phase II trial of intraluminal irrigation with recombinant human tissue factor pathway inhibitor to prevent thrombosis in free flap surgery. Plast Reconstr Surg. 2001;107:408–15.
86- Chiu TW, Leung CC, Lau EY, Burd A. Analgesic effects of preoperative gabapentin after tongue reconstruction with the anterolateral thigh flap. Hong Kong Med J. 2012;18:30–4.
87- Lee KT, Jeon BJ, Lim SY, Pyon JK, Bang SI, Oh KS, et al. The effects of ketorolac on microvascular thrombosis in lower extremity reconstruction. Plast Reconstr Surg. 2012;129:1322–7.
88- Heller L, Kowalski AM, Wei C, Butler CE. Prospective, randomized, double-blind trial of local anesthetic infusion and intravenous narcotic patient-controlled anesthesia pump for pain management after free TRAM flap breast reconstruction. Plast Reconstr Surg. 2008;122:1010–8.
89- Zhong T, Wong KW, Cheng H, Ohja M, Srivinas C, Mccluskey SA, et al. Transversus abdominis plane catheters inserted under direct vision in the donor site following free DIEP and MS-TRAM breast reconstruction: A prospective cohort study of 45 patients. J Plast Reconstr Aesthet Surg. 2013;66:329–36.
90- Wheble GA, Tan EK, Turner M, Durrant CA, Heppell S. Surgeon-administered, intra-operative transversus abdominis plane block in autologous breast reconstruction: A UK hospital experience. J Plast Reconstr Aesthet Surg. 2013;66:1665–70.
91- Bhatnagar S, Saxena A, Kannan TR, Punj J. Tramadol for postoperative shivering: a double-blind comparison with pethidine. Anaesth Intensive Care. 2001;29:149-54.
92- Rosenberg JJ, Fornage BD, Chevray PM. Monitoring buried free flaps: limitations of the implantable Doppler and use of color duplex sonography as a confirmatory test. Plast Reconstr Surg. 2006;118:109-13.

Ayrıntılar

Birincil Dil

Türkçe

Konular

Sağlık Kurumları Yönetimi

Bölüm

Derleme

Yazarlar

Murat Türkeün Ilgınel ^*
Çukurova Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon A.D.
0000-0001-9183-9124
Türkiye

Yayımlanma Tarihi

30 Haziran 2019

Gönderilme Tarihi

27 Şubat 2018

Kabul Tarihi

25 Nisan 2018

Yayımlandığı Sayı

Yıl 2019 Cilt: 28 Sayı: 2

IZ

https://izlik.org/JA87AK54ZR

AMA

1.Ilgınel MT. Serbest Doku Flebi Cerrahisinde Anestezi. aktd. 2019;28(2):108-118. https://izlik.org/JA87AK54ZR

Serbest Doku Flebi Cerrahisinde Anestezi

Serbest Doku Flebi Cerrahisinde Anestezi

Öz

Anahtar Kelimeler

Anesthesia in Free Flap Surgery

Abstract

Keywords

Kaynakça

Ayrıntılar

Birincil Dil

Konular

Bölüm

Yazarlar

Yayımlanma Tarihi

Gönderilme Tarihi

Kabul Tarihi

Yayımlandığı Sayı

IZ

Kaynak Göster