Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan; Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan; Department of Plastic Surgery, Noda Hospital, Chiba, Japan.
J Plast Reconstr Aesthet Surg. 2023 Sep;84:567-573. doi: 10.1016/j.bjps.2023.06.055. Epub 2023 Jun 27.
Free flap transfer (FFT) is essential in soft tissue reconstruction and can be done under local anesthesia. However, there is no study evaluating the feasibility of FFT without hospitalization. This study evaluated the feasibility of day microsurgery-FFT as a day surgery without hospitalization.
Patients who underwent day microsurgery were included. The FFT was performed under local infiltration and/or block anesthesia without sedation by a surgeon with enough experience in supermicrosurgery. We focused on minimal dissection and secure hemostasis to prevent possible complications. Patient characteristics, operative findings, and postoperative course were evaluated.
Seventeen patients with a mean age of 40.4 years were included. All defects were of the upper extremity and due to trauma. Utilized anesthesia included local infiltration in 11 sites, digital block in 10 sites, wrist block in 12 sites, and elbow block in 4 sites. Used flap included superficial circumflex iliac artery perforator flap in 8 (47.1%) cases and short-pedicle partial toe flaps in 9 (52.9%) cases. The mean diameters of the anastomosed artery/vein were 0.88/1.29 mm, and the mean operation time was 68.9 min. All transferred flaps survived without total or partial necrosis. The postoperative course was uneventful except for 1 (5.9%) case with minor wound dehiscence.
FFT could safely be performed without hospitalization in selected cases of an upper extremity defect. Supermicrosurgery and careful patient selection play an important role in safe day microsurgery.
游离皮瓣移植（FFT）在软组织重建中至关重要，可在局部麻醉下进行。然而，目前尚无研究评估不在医院进行 FFT 的可行性。本研究评估了不在医院进行日间显微手术-FFT 作为日间手术的可行性。
纳入接受日间显微手术的患者。FFT 由具有丰富超显微外科经验的外科医生在局部浸润和/或神经阻滞麻醉下进行，无需镇静。我们专注于最小化解剖和确保止血，以预防可能的并发症。评估患者特征、手术发现和术后过程。
纳入 17 例平均年龄为 40.4 岁的患者。所有缺损均在上肢，且由于创伤所致。使用的麻醉包括 11 处局部浸润麻醉、10 处指神经阻滞麻醉、12 处腕部阻滞麻醉和 4 处肘部阻滞麻醉。使用的皮瓣包括旋髂浅动脉穿支皮瓣 8 例（47.1%）和短蒂部分趾瓣 9 例（52.9%）。吻合的动脉/静脉的平均直径分别为 0.88/1.29mm，平均手术时间为 68.9 分钟。所有移植的皮瓣均存活，无全部或部分坏死。除 1 例（5.9%）出现轻微伤口裂开外，术后过程均无异常。
在选择的上肢缺损病例中，FFT 可安全地不在医院进行。超显微外科和仔细的患者选择在安全的日间显微手术中发挥重要作用。
