The care and feeding of microvascular flaps: how nurses can help prevent flap loss.

Free flaps are used to reconstruct defects that cannot be repaired by traditional methods using local adjacent tissue. Advantages include a single operation, decreased immobility, increased vascular supply to tissues for healing, minimal risk of flap loss, and primary closure of the donor site. Disadvantages are a long operation, two surgical sites, need for surgery if vascular compromise occurs, donor site morbidity, and expense. Preoperative care focuses on readiness for surgery and avoidance of medications (nicotine, caffeine) and situations (cold exposure) that cause vasospasm. Intraoperative nursing care includes positioning, range of motion, and pneumatic compression devices for the long case. The operating microscope requires special care and instruments. After surgery, blood flow to the flap is closely monitored. Laser flow Doppler can be used with data recorded on a flow sheet. Common postoperative problems include temperature instability, pain, blood pressure fluctuations, and oliguria. Dismissal teaching includes avoidance of vasoconstrictive medications and dressing changes.