Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, University Hospital of Basel, Basel, Switzerland.
J Plast Reconstr Aesthet Surg. 2016 Aug;69(8):1092-6. doi: 10.1016/j.bjps.2016.04.021. Epub 2016 May 17.
With increasing appreciation of the possible adverse effects of peri-operative blood transfusion, restrictive policies regarding use of blood products have been adopted in many surgical specialties. Although microvascular breast reconstruction has become a routine procedure, high peri-operative transfusion rates continue to be reported in the literature. In this study we examine the impact of our restrictive approach on blood transfusion rates and postoperative complications in patients undergoing microvascular blood transfusion.
A retrospective review of patients undergoing microvascular breast reconstruction with abdominal flaps at a single institution was performed. Patient age and body mass index as well as type, timing and laterality of reconstruction was recorded. Pre-operative and post-operative hemoglobin and hematocrit were recorded. Peri-operative blood transfusion rates were calculated. Post-operative complication rates were compared between patients with higher and lower post-operative hemoglobin levels.
Five hundred and twelve patients were included in this study. The peri-operative transfusion rate was 0.98% in this series. There was no significant difference between transfusion rates in unilateral and bilateral reconstructions (0.68 vs 1.36% p = 0.08) or immediate and delayed reconstructions (1.02 vs 0.51% p = 0.72 and 1.01 vs 1.60% p = 0.09 for unilateral and bilateral respectively). Lower post-operative hemoglobin levels were not associated with increased flap related, surgical or medical complications rates.
A restrictive approach to peri-operative blood transfusion can be safely adopted in microvascular breast reconstruction without compromising flap viability or overall complication rates.
随着人们对围手术期输血可能产生的不良反应认识的不断提高，许多外科专业已开始采用限制用血制品的政策。虽然微血管乳房重建已成为常规手术，但文献中仍持续报告高围手术期输血率。在这项研究中，我们研究了我们的限制输血策略对接受微血管输血的患者的输血率和术后并发症的影响。
对一家机构中接受腹部皮瓣微血管乳房重建的患者进行了回顾性研究。记录了患者年龄、体重指数以及重建的类型、时间和侧别。记录了术前和术后血红蛋白和血细胞比容。计算了围手术期输血率。比较了术后血红蛋白水平较高和较低患者的术后并发症发生率。
本研究共纳入 512 例患者。本系列的围手术期输血率为 0.98%。单侧和双侧重建（0.68%比 1.36%，p=0.08）或即刻和延迟重建（1.02%比 0.51%，p=0.72 和 1.01%比 1.60%，p=0.09）的输血率之间无显著差异。较低的术后血红蛋白水平与皮瓣相关、手术或医疗并发症发生率增加无关。
在微血管乳房重建中，采用限制围手术期输血的策略可以安全实施，而不会影响皮瓣存活率或整体并发症发生率。
