Fazzalari Amanda, Gebhardt Susanna, Hamaguchi Ryoko, Agarwal Shailesh
Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, United States.
Division of Plastic and Reconstructive Surgery, Lahey Hospital and Medical Center, Burlington, MA, United States.
Front Surg. 2025 Mar 5;12:1513082. doi: 10.3389/fsurg.2025.1513082. eCollection 2025.
Pressure injuries (PI) that develop in the operating room (OR) account for just under half of all hospital acquired pressure injuries (HAPI) and contribute significantly to the high cost and patient morbidity of HAPI. Microvascular autologous breast reconstruction poses specific risks to PI development in patients and should be addressed by the reconstructive microsurgeon. Standard risk factors for perioperative PI include patient immobility, absent pain perception, and challenges to maintaining normal body temperature while under general anesthesia for surgery. Specific intraoperative risk factors relevant to patients undergoing microvascular autologous breast reconstruction include extended length of surgery and patient repositioning. The risk of PI increases significantly when operative time exceeds 3 h and patient repositioning, with changes in positioning subjecting specific anatomic locations to increased pressure and friction. For these reasons, placement of positioning devices at high-risk anatomical locations is particularly important, such as the use of polyurethane or polyether mattresses, multilayered silicone foam dressings, and gel, foam, or fluidized positioners. The implementation of periodic body positioning checks and clear communication between surgical teams regarding awareness and status of pressure points is helpful in mitigating risk of perioperative PI. Preoperative risk assessments and skin exams may also be useful, as well as postoperative skin exams and early movement out of bed on postoperative day 0 and ambulation on postoperative day 1. These guidelines will reduce the risk of PI development in patients undergoing reconstructive breast surgery.
手术室中发生的压力性损伤（PI）占所有医院获得性压力性损伤（HAPI）的近一半，对HAPI的高成本和患者发病率有重大影响。微血管自体乳房重建给患者带来了发生PI的特定风险，重建显微外科医生应予以关注。围手术期PI的标准风险因素包括患者活动不便、无痛觉以及在全身麻醉手术期间维持正常体温面临挑战。与微血管自体乳房重建患者相关的特定术中风险因素包括手术时间延长和患者体位重新摆放。当手术时间超过3小时且患者体位重新摆放时，PI的风险会显著增加，因为体位改变会使特定解剖部位承受更大的压力和摩擦。出于这些原因，在高风险解剖部位放置定位装置尤为重要，例如使用聚氨酯或聚醚床垫、多层硅胶泡沫敷料以及凝胶、泡沫或流化定位器。定期进行身体体位检查并在手术团队之间就压力点的知晓情况和状态进行清晰沟通，有助于降低围手术期PI的风险。术前风险评估和皮肤检查可能也有用，术后皮肤检查以及术后第0天尽早下床活动和术后第1天进行走动也有帮助。这些指南将降低接受乳房重建手术患者发生PI的风险。
