García-Ordaz B, Mutis-Ospino BE

Idioma: Español
Referencias bibliográficas: 15
Paginas: 109-112
Archivo PDF: 116.94 Kb.

FRAGMENTO

Los procedimientos de microcirugía reconstructiva, especialmente en colgajos microanastomosados, con implantación de nervios y vasos por trauma o amputación, así como los trasplantes autólogos de piel y músculos, han introducido al anestesiólogo a nuevos retos en el contexto perioperatorio desde que se introdujo por primera vez la transferencia de tejido libre en 1960.
Los índices de éxito actuales en cirujanos con experiencia son del 95-99% y el papel del anestesiólogo en este sentido, cobra vital importancia, ya que por medio de un adecuado plan preanestésico (con la identificación de factores de mal pronóstico y/o comorbilidades), adecuada elección de la técnica anestésica, monitorización apropiada, manejo intraoperatorio de la hipotensión, temperatura, glicemia, transfusiones y seguimiento postanestésico con excelente analgesia postoperatoria, la vialidad de los colgajos es mayor y las complicaciones son menores.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Rand A, Ayoub M, Meyer-Frießem CH, et al. Anesthesia management in microsurgical reconstructions. Anaesthesist. August 201; Published online: DOI: 10.1007/s00101-017-0349-6.

2. Hwang K, Lee JP, Yoo SY, Kim H. The relationships of comorbidities and old age with postoperative complications of head and neck free flaps: a review, British Journal of Plastic Surgery 2016; Published online DOI: 10.1016/j.bjps.2016.08.018.

3. Hand WR, McSwain JR, McEvoy MD, et al. Characteristics and intraoperative treatments associated with head and neck free tissue transfer complications and failures. Otolaryngol Head Neck Surg. 2015;152:480-487.

4. Kenneth L Fan, et al. Evidence to Support Controversy in Microsurgery. Plast Reconstr Surg. 2015;135:595e-608e.

5. Khan MN, Russo J, Spivack J, et al. Association of body mass index with infectious complications in free tissue transfer for head and neck reconstructive surgery. JAMA Otolaryngol Head Neck Surg. 2017;143:574-579.

6. Roechl K. Mahabir R: A practical guide to free tissue transfer. Plast. Reconstr Surg. July 2013; 132: 147 – 158e

7. Adams J, Charlton P. Anaesthesia for microvascular free tissue transfer. British Journal of anaesthesia. 2003;3:33-37.

8. Motakef S, et al. 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.

9. Chang YT, et al. Differences between total intravenous anesthesia and inhalation anesthesia in free flap surgery of head and neck cancer. Plos One. 2016; Published online; DOI:10.1371/journal.pone.0147713.g001.

10. Kim A, et al. Regional anesthesia alone for pediatric free flaps. Journal of plastic, reconstructive & aesthetic surgery. July 2015; Published online; DOI: 10.1016/j.bjps.2015.02.019.

11. Jayaram K, et al. Evaluation of the effect of regional anaesthesia on microvascular free flaps. Turk J Anaesthesiol Reanim. 2018;46:441-6.

12. Kim B, et al. Anesthesia duration as an independent risk factor for postoperative complications in free flap surgery: A review of 1,305 surgical cases. J Reconstr Microsurg. 2014;30:217-226.

13. Brady J, et al. Association of anesthesia duration with complications after microvascular reconstruction or the head and neck. JAMA Facial Plastic Surgery, October 2017; Published online;DOI:10.1001/jamafacial.2017.1607.

14. Lou F, et al. Epidural combined with general anesthesia versus general anesthesia alone in patients undergoing free flap breast reconstruction. Plast Reconstr Surg. 2016;137:502e-509e.

15. Motakef S, et al. Perioperative management for microsurgical free tissue transfer: Survey of current practices with a comparison to the literature. J Reconstr Microsurg. 2015;31:355-363.