Department of Plastic and Hand Surgery, Burn Unit, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck 23538, Germany.
Microsurgery. 2010;30(3):214-7. doi: 10.1002/micr.20736.
Free tissue transfer in reconstruction of lower extremity wounds is well established. Controversy surrounds type and regimen of intravenous fluid application during microsurgery. Hemodilution is supposed to influence haemostatic process.
We performed an analysis of 48 patients treated with a free latissimus dorsi muscle flap to the lower leg for posttraumatic soft-tissue coverage. Postoperative latissimus dorsi muscle flap perfusion was controlled by clinical monitoring. Intraoperative infusion management was evaluated retrospectively.
In 4 of 48 included patients, a complete loss of free latissimus dorsi muscle flap was registered. Concomitant increased saline infusion was detected (4,534 ml versus. 6,125 ml; P = 0.048). Similar findings for relation of total infusion volume to body weight were seen (44 ml/kg versus 69 ml/kg; P = 0.01). No significant colloid infusion was detected.
We demonstrate the clinical relevance of extensive intraoperative hyperhydration, which can provoke a complete free flap loss.
游离组织移植在下肢创伤重建中已得到广泛应用。在显微外科手术中，关于静脉输液的类型和方案仍存在争议。血液稀释被认为会影响止血过程。
我们对 48 例因创伤后软组织缺损而接受游离背阔肌皮瓣修复的患者进行了分析。术后通过临床监测来控制背阔肌皮瓣的灌注。回顾性评估术中输液管理。
在 48 例纳入患者中，有 4 例出现游离背阔肌皮瓣完全坏死。同时发现盐水输注量增加（4534ml 比 6125ml；P=0.048）。总输液量与体重的关系也有类似的发现（44ml/kg 比 69ml/kg；P=0.01）。未发现显著的胶体输注。
我们证明了术中过度水化的临床相关性，它可能导致游离皮瓣完全坏死。
