Yusufcan Ekin1, İlkben Günüşen1, Özlem Yakut Özdemir1, Yiğit Özer Tiftikçioğlu2. 1. Department of Anaesthesiology and Reanimation, Ege University School of Medicine, İzmir, Turkey. 2. Department of Plastic, Aesthetic and Reconstructive Surgery, Ege University School of Medicine, İzmir, Turkey.
Abstract
OBJECTIVE: Free flap surgeries constitute the basis of reconstruction surgery in patients with major defects. Prediction of complications that cause flap loss in such patients is important in terms of reducing the length of hospital stay and expenses. We aimed to retrospectively investigate the effect of co-morbidities and the coagulation status on flap loss and complications in patients with reconstructed free flap. METHODS: Demographic data, smoking, alcohol habits, co-morbidities, coagulation tests and thromboelastogram results from preoperative, intraoperative and postoperative anaesthesia and surgical records of patients undergoing free flap surgeries between January 2015 and June 2017 were retrospectively screened. RESULTS: Flap success rate was found to be 96.1% in total 77 patients with free flap. Coagulation related complication rate, such as thrombosis, haematoma and partial necrosis, were 22.1%. There was a significant relationship between age, chronic obstructive pulmonary disease and hypercholesterolaemia and flap loss (p=0.006, p=0.025 ve p=0.025, respectively). Flap complications were more frequent in patients with chronic obstructive pulmonary disease and hypertension. Laboratory test results revealed no statistical correlation between flap complications and flap loss with preoperative and postoperative TEG. CONCLUSION: Advanced age, co-morbidities such as hypertension and chronic obstructive pulmonary disease are associated with complications and flap loss in free flap surgery. However, there were no clinically significant association of complications and flap loss with laboratory tests showing coagulation. We believe that standardised protocols should be established in terms of preparation, intraoperative management and postoperative follow-ups because the time between taking the coagulation tests and postoperative anticoagulant administration should be standardised in such surgeries.
OBJECTIVE: Free flap surgeries constitute the basis of reconstruction surgery in patients with major defects. Prediction of complications that cause flap loss in such patients is important in terms of reducing the length of hospital stay and expenses. We aimed to retrospectively investigate the effect of co-morbidities and the coagulation status on flap loss and complications in patients with reconstructed free flap. METHODS: Demographic data, smoking, alcohol habits, co-morbidities, coagulation tests and thromboelastogram results from preoperative, intraoperative and postoperative anaesthesia and surgical records of patients undergoing free flap surgeries between January 2015 and June 2017 were retrospectively screened. RESULTS: Flap success rate was found to be 96.1% in total 77 patients with free flap. Coagulation related complication rate, such as thrombosis, haematoma and partial necrosis, were 22.1%. There was a significant relationship between age, chronic obstructive pulmonary disease and hypercholesterolaemia and flap loss (p=0.006, p=0.025 ve p=0.025, respectively). Flap complications were more frequent in patients with chronic obstructive pulmonary disease and hypertension. Laboratory test results revealed no statistical correlation between flap complications and flap loss with preoperative and postoperative TEG. CONCLUSION: Advanced age, co-morbidities such as hypertension and chronic obstructive pulmonary disease are associated with complications and flap loss in free flap surgery. However, there were no clinically significant association of complications and flap loss with laboratory tests showing coagulation. We believe that standardised protocols should be established in terms of preparation, intraoperative management and postoperative follow-ups because the time between taking the coagulation tests and postoperative anticoagulant administration should be standardised in such surgeries.
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