Free tissue transfer in pregnancy: Guidelines for perioperative management

✍ Scribed by G. Robert Meger; W. Tomasz Majewski; W. Glenn Lyle

• Book ID: 102510514
• Publisher: John Wiley and Sons
• Year: 2001
• Tongue: English
• Weight: 208 KB
• Volume: 21
• Category: Article
• ISSN: 0738-1085
• DOI: 10.1002/micr.1039

✦ Synopsis

Abstract

A successful free tissue transfer of serratus anterior muscle, to provide coverage for an open ankle defect in a pregnant patient, is described. Microvascular surgery in the presence of a viable pregnancy demands considerations unique to this situation. Although rarely possible, an attempt should be made to plan surgery to coincide with the second trimester, to lessen the risk of anesthesia to the fetus. Maternal positioning, fluid balance, and aspiration precautions need to be critically addressed. Close perioperative monitoring by an obstetrician is essential. The condition of pregnancy results in a hypercoagulable state that may lead to an increased risk of anastomotic failure. The use of anticoagulants results in increased risk of bleeding, not only for the patient but also for the fetus, as well as risk of teratogenic effects. Closely monitored heparin is considered safe in pregnancy as is low‐molecular‐weight dextran and low‐dose aspirin. Additional considerations include the use of narcotics and sedatives for comfort postoperatively, as well as antibiotic choices, if indicated. © 2001 Wiley‐Liss, Inc. Microsurgery 21:202–207 2001