The Clinical Role of Intraoperative Core Temperature in Free Tissue Transfer

Hill, John; Sexton, Kevin W.; Bartlett, Erica L.; Papillion, Paul; Corral, Gabriel A. Del; Patel, Ashit; Guillamondegui, Oscar D.; Shack, R. Bruce

doi:10.1097/sap.0000000000000210

Cited by 17 publications

(7 citation statements)

References 18 publications

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“…46 However, hypothermia has been associated with perioperative complications in the majority of studies. 11,12,47 In an animal study, intraoperative hypothermia reduced flap flow and postocclusive hyperemia. 47 Intraoperative hypothermia (minimum core temperature, <35°C) has also been correlated with perioperative complications in patients.…”

Section: Patient Temperaturementioning

confidence: 98%

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Motakef

Mountziaris

Ismail

et al. 2015

Plastic and Reconstructive Surgery

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Current practices remain exceedingly diverse. Key strategies to improve patient outcomes can be defined from the available literature. Key evidence-based guidelines included that normothermia should be maintained perioperatively to improve outcomes (level of evidence 2b), and volume replacement should be maintained between 3.5 and 6.0 ml/kg per hour (level of evidence 2b). Vasopressors do not harm outcomes and may improve flap flow (level of evidence 1b), with most evidence supporting the use of norepinephrine over other vasopressors (level of evidence 1b). Dextran should be avoided (level of evidence 1b), and pump systems for local anesthetic infusion are beneficial following free flap breast reconstruction (level of evidence 1b). Further prospective studies will improve the quality of available evidence.

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Section: Patient Temperaturementioning

confidence: 98%

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Motakef

Mountziaris

Ismail

et al. 2015

Plastic and Reconstructive Surgery

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“…Recently, the role of intraoperative hypothermia has gained attention. [13][14][15][16] Free-flap reconstructions are regularly performed in two operating teams. 17 This exposes large skin surface areas, which increases patients' susceptibility to hypothermia.…”

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confidence: 99%

“…17 This exposes large skin surface areas, which increases patients' susceptibility to hypothermia. 15,18 In general, hypothermia causes peripheral vasoconstriction, an increase in blood viscosity and a reduced blood flow, which can ultimately lead to increased thrombogenic potential. 14,[19][20][21] Conversely, therapeutic hypothermia has been shown to reduce hypoxemia and ischemia in a wide range of different settings, such as acute myocardial infarction 22,23 or organ preservation, prior to transplantation.…”

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confidence: 99%

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Impact of Intraoperative Hypothermia on Microsurgical Free Flap Reconstructions

Moellhoff

Broer

Heidekrueger

et al. 2020

J Reconstr Microsurg

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Background Patients requiring microsurgical defect reconstruction are highly susceptible to intraoperative hypothermia, given oftentimes long operative times and exposure of large skin surface areas. While the impact of hypothermia has been extensively studied across various surgical fields, its role in the setting of microsurgical free flap reconstruction remains elusive. This study evaluates the effects of hypothermia on outcomes of free flap reconstructions. Methods Within 7 years, 602 patients underwent 668 microvascular free flap reconstructions. The cases were divided into two groups regarding the minimal core body temperature during free flap surgery: hypothermia (HT; < 36.0°C) versus normothermia (NT; ≥36.0°C). The data were retrospectively screened for patients' demographics, perioperative details, flap survival, surgical complications, and outcomes. Results Our data revealed no significant difference with regard to the rate of major and minor surgical complications, or the rate of revision surgery between both groups (p > 0.05). However, patients in the HT group showed significantly higher rates of total flap loss (6.6% [HT] vs. 3.0% [NT], p < 0.05) and arterial thrombosis (4.6% [HT] vs. 1.9% [NT], p < 0.05). This translated into a significantly longer hospitalization of patients with reduced core body temperature (HT: mean 16.8 days vs. NT: mean 15.1 days; p < 0.05). Conclusion Hypothermia increases the risk for arterial thrombosis and total flap loss. While free flap transfer is feasible also in hypothermic patients, surgeons' awareness of core body temperature should increase. Taken together, we suggest that the mean intraoperative minimum temperature should range between 36 and 36.5°C during free flap surgery as a pragmatic guideline.

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“…9 In addition, normothermia has been shown to reduce surgical-site infection. 10,11 Hypothermia causes impaired platelet function, increased blood loss and transfusion requirements, prolonged hospitalization, 12 and increased cardiac events in patients with coronary artery disease. 13 A Cochrane review of 24 studies found that using warm intravenous fluids helped prevent hypothermia better than room-temperature fluids.…”

Section: Anesthesia Considerationsmentioning

confidence: 99%

Evidence-Based Strategies to Reduce Postoperative Complications in Plastic Surgery

Harrison

Khansa

Janis

2016

Plastic and Reconstructive Surgery

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Reconstructive plastic surgery is vital in assisting patients with reintegration into society after events such as tumor extirpation, trauma, or infection have left them with a deficit of normal tissue. Apart from performing a technically sound operation, the plastic surgeon must stack the odds in the favor of the patient by optimizing them before and after surgery. The surgeon must look beyond the wound, at the entire patient, and apply fundamental principles of patient optimization. This article reviews the evidence behind the principles of patient optimization that are commonly used in reconstructive surgery patients.

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The Clinical Role of Intraoperative Core Temperature in Free Tissue Transfer

Abstract: Intraoperative hypothermia posed significant risk of flap infection with no benefit to anastomotic patency in free tissue transfer.

Cited by 17 publications

References 18 publications

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Impact of Intraoperative Hypothermia on Microsurgical Free Flap Reconstructions

Evidence-Based Strategies to Reduce Postoperative Complications in Plastic Surgery

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