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J Reconstr Microsurg 2019; 35(09): 631-639
DOI: 10.1055/s-0039-1693142
Invited Review
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patient Safety in Microvascular Plastic Surgery

Salih Colakoglu
1   Division of Plastic and Reconstructive Surgery, University of Colorado Hospital, Aurora, Colorado
,
Seth Tebockhorst
2   Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Tae W. Chong
1   Division of Plastic and Reconstructive Surgery, University of Colorado Hospital, Aurora, Colorado
,
David W. Mathes
1   Division of Plastic and Reconstructive Surgery, University of Colorado Hospital, Aurora, Colorado
› Author Affiliations
Further Information

Publication History

19 December 2018

15 May 2019

Publication Date:
21 July 2019 (online)

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Abstract

Patient safety is defined as freedom from accidental or preventable harm produced by medical care. The identification of patient- and procedure-related risk factors enables the surgical team to carry out prophylactic measures to reduce the rate of complications and adverse events.

The purpose of this review is to identify the characteristics of patients, practitioners, and microvascular surgical procedures that place patients at risk for preventable harm, and to discuss evidence-based prevention practices that can potentially help to generate a culture of patient safety.

Keywords

patient safety - microsurgery - microvascular surgery - free flap

Disclosure

The authors have no financial interests in this research project or in any of the techniques or equipment used in this study.


 

  • References

  • 1 Agency for Healthcare Research and Quality. PSNet Glossary. Patient Safety. Available at: https://psnet.ahrq.gov/glossary/p . Accessed December 15, 2018
    PubMedGoogle Scholar
  • 2 Levine SM, Wilson SC, Sinno S, Rothwax J, Dillon A, Saadeh PB. Plastic surgery mortality: an 11-year, single-institution experience. Ann Plast Surg 2016; 76 (05) 556-558
    CrossrefPubMedGoogle Scholar
  • 3 Fan KL, Patel KM, Mardini S, Attinger C, Levin LS, Evans KK. Evidence to support controversy in microsurgery. Plast Reconstr Surg 2015; 135 (03) 595e-608e
    CrossrefPubMedGoogle Scholar
  • 4 Ehrl D, Heidekrueger PI, Ninkovic M, Broer PN. Effect of preoperative medical status on microsurgical free flap reconstructions: a matched cohort analysis of 969 cases. J Reconstr Microsurg 2018; 34 (03) 170-175
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Fortin AJ, Evans HB, Chu MW. The cardiac implications of breast reconstruction using the internal mammary artery as the recipient vessel. Can J Plast Surg 2012; 20 (01) e16-e18
    CrossrefPubMedGoogle Scholar
  • 6 Evans GRD. Reconstructive Surgery of the Chest, Abdomen and Pelvis. New York: Dekker; 2004
    Google Scholar
  • 7 Chiang S, Cohen B, Blackwell K. Myocardial infarction after microvascular head and neck reconstruction. Laryngoscope 2002; 112 (10) 1849-1852
    CrossrefPubMedGoogle Scholar
  • 8 Nouraei SA, Al-Yaghchi C, Sandhu GS, Giussani DA, Doyle P, Clarke PM. Incidence and significance of myocardial injury after surgical treatment of head and neck cancer. Laryngoscope 2007; 117 (09) 1581-1587
    CrossrefPubMedGoogle Scholar
  • 9 Grant DW, Mlodinow A, Ver Halen JP, Kim JY. Catastrophic outcomes in free tissue transfer: a six-year review of the NSQIP database. Plast Surg Int 2014; 2014: 704206
    PubMedGoogle Scholar
  • 10 Fleisher LA, Fleischmann KE, Auerbach AD. , et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Circulation 2014; 130 (24) 2215-2245
    CrossrefPubMedGoogle Scholar
  • 11 Jubbal KT, Zavlin D, Suliman A. The effect of age on microsurgical free flap outcomes: an analysis of 5,951 cases. Microsurgery 2017; 37 (08) 858-864
    CrossrefPubMedGoogle Scholar
  • 12 Weitgasser L, Amr A, Hladik M. , et al. The impact of age on perioperative complications after extremity reconstruction with the free gracilis flap: a retrospective cohort study involving 153 patients. J Reconstr Microsurg 2019; 35 (06) 395-410
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Patel VM, Stern C, Miglani A. , et al. Evaluation of the relationship between age and outcome after microvascular reconstruction among patients with recurrent head and neck squamous cell carcinoma. J Reconstr Microsurg 2017; 33 (05) 336-342
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Barr LC, Joyce AD. Microvascular anastomoses in diabetes: an experimental study. Br J Plast Surg 1989; 42 (01) 50-53
    CrossrefPubMedGoogle Scholar
  • 15 Cooley BC, Hanel DP, Anderson RB, Foster MD, Gould JS. The influence of diabetes on free flap transfer: I. Flap survival and microvascular healing. Ann Plast Surg 1992; 29 (01) 58-64
    CrossrefPubMedGoogle Scholar
  • 16 Rosado P, Cheng HT, Wu CM, Wei FC. Influence of diabetes mellitus on postoperative complications and failure in head and neck free flap reconstruction: a systematic review and meta-analysis. Head Neck 2015; 37 (04) 615-618
    CrossrefPubMedGoogle Scholar
  • 17 Moran SL, Illig KA, Green RM, Serletti JM. Free-tissue transfer in patients with peripheral vascular disease: a 10-year experience. Plast Reconstr Surg 2002; 109 (03) 999-1006
    CrossrefPubMedGoogle Scholar
  • 18 Jang YJ, Park MC, Hong YS. , et al. Successful lower extremity salvage with free flap after endovascular angioplasty in peripheral arterial occlusive disease. J Plast Reconstr Aesthet Surg 2014; 67 (08) 1136-1143
    CrossrefPubMedGoogle Scholar
  • 19 Mimoun M, Hilligot P, Baux S. The nutrient flap: a new concept of the role of the flap and application to the salvage of arteriosclerotic lower limbs. Plast Reconstr Surg 1989; 84 (03) 458-467
    CrossrefPubMedGoogle Scholar
  • 20 Moran SL, Salgado CJ, Serletti JM. Free tissue transfer in patients with renal disease. Plast Reconstr Surg 2004; 113 (07) 2006-2011
    CrossrefPubMedGoogle Scholar
  • 21 Manrique OJ, Ciudad P, Sharaf B. , et al. Free tissue transfers for head and neck reconstruction in patients with end-stage renal disease on dialysis: analysis of outcomes using the Taiwan National Health Insurance Research Database. J Reconstr Microsurg 2017; 33 (08) 587-591
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Chien SH, Huang CC, Hsu H, Chiu CH, Lin CM, Tsai JP. Free tissue transfers for limb salvage in patients with end-stage renal disease on dialysis. Plast Reconstr Surg 2011; 127 (03) 1222-1228
    CrossrefPubMedGoogle Scholar
  • 23 Chang DW, Wang B, Robb GL. , et al. Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg 2000; 105 (05) 1640-1648
    CrossrefPubMedGoogle Scholar
  • 24 Jandali S, Nelson JA, Sonnad SS. , et al. Breast reconstruction with free tissue transfer from the abdomen in the morbidly obese. Plast Reconstr Surg 2011; 127 (06) 2206-2213
    CrossrefPubMedGoogle Scholar
  • 25 Selber JC, Kurichi JE, Vega SJ, Sonnad SS, Serletti JM. Risk factors and complications in free TRAM flap breast reconstruction. Ann Plast Surg 2006; 56 (05) 492-497
    CrossrefPubMedGoogle Scholar
  • 26 Garvey PB, Buchel EW, Pockaj BA, Gray RJ, Samson TD. The deep inferior epigastric perforator flap for breast reconstruction in overweight and obese patients. Plast Reconstr Surg 2005; 115 (02) 447-457
    CrossrefPubMedGoogle Scholar
  • 27 Kroll SS, Schusterman MA, Reece GP. , et al. Choice of flap and incidence of free flap success. Plast Reconstr Surg 1996; 98 (03) 459-463
    CrossrefPubMedGoogle Scholar
  • 28 Panayi AC, Agha RA, Sieber BA, Orgill DP. Impact of obesity on outcomes in breast reconstruction: a systematic review and meta-analysis. J Reconstr Microsurg 2018; 34 (05) 363-375
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Garvey PB, Villa MT, Rozanski AT, Liu J, Robb GL, Beahm EK. The advantages of free abdominal-based flaps over implants for breast reconstruction in obese patients. Plast Reconstr Surg 2012; 130 (05) 991-1000
    CrossrefPubMedGoogle Scholar
  • 30 Heidekrueger PI, Heine-Geldern A, Ninkovic M, Herter F, Mueller C, Broer PN. Extending the limits of microsurgical reconstruction in patients with moderate to very severe obesity: single-center 6-year experiences. J Reconstr Microsurg 2017; 33 (02) 124-129
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Cleveland EC, Fischer JP, Nelson JA, Wink JD, Levin LS, Kovach III SJ. Free flap lower extremity reconstruction in the obese population: does weight matter?. J Reconstr Microsurg 2014; 30 (04) 263-270
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Rifkin WJ, Kantar RS, Daar DA. , et al. Obesity and lower extremity reconstruction: evaluating body mass index as an independent risk factor for early complications. J Reconstr Microsurg 2018; 35 (05) 346-353
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Shum J, Markiewicz MR, Park E. , et al. Low prealbumin level is a risk factor for microvascular free flap failure. J Oral Maxillofac Surg 2014; 72 (01) 169-177
    CrossrefPubMedGoogle Scholar
  • 34 Lawson BR, Moreno MA. Head and Neck Reconstruction with Chimeric Anterolateral Thigh Free Flap: Indications, Outcomes, and Technical Considerations. Otolaryngol Head Neck Surg 2016; 154 (01) 59-65
    CrossrefPubMedGoogle Scholar
  • 35 Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg 2006; 117 (7, Suppl): 42S-58S
    CrossrefPubMedGoogle Scholar
  • 36 Russell NS, Hoving S, Heeneman S. , et al. Novel insights into pathological changes in muscular arteries of radiotherapy patients. Radiother Oncol 2009; 92 (03) 477-483
    CrossrefPubMedGoogle Scholar
  • 37 Halle M, Gabrielsen A, Paulsson-Berne G. , et al. Sustained inflammation due to nuclear factor-kappa B activation in irradiated human arteries. J Am Coll Cardiol 2010; 55 (12) 1227-1236
    CrossrefPubMedGoogle Scholar
  • 38 Lee BT, , A Adesiyun T, Colakoglu S. , et al. Postmastectomy radiation therapy and breast reconstruction: an analysis of complications and patient satisfaction. Ann Plast Surg 2010; 64 (05) 679-683
    CrossrefPubMedGoogle Scholar
  • 39 Rogers NE, Allen RJ. Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap. Plast Reconstr Surg 2002; 109 (06) 1919-1924 , discussion 1925–1926
    CrossrefPubMedGoogle Scholar
  • 40 Dadaci M, Oztekin C, Oztekin PS, Sargon MF, Ozgur F. Effect of a combined oral contraceptive on patency of arterial anastomosis in a female rat model. Microsurgery 2015; 35 (07) 553-559
    CrossrefPubMedGoogle Scholar
  • 41 Kelley BP, Valero V, Yi M, Kronowitz SJ. Tamoxifen increases the risk of microvascular flap complications in patients undergoing microvascular breast reconstruction. Plast Reconstr Surg 2012; 129 (02) 305-314
    CrossrefPubMedGoogle Scholar
  • 42 Mirzabeigi MN, Nelson JA, Fischer JP. , et al. Tamoxifen (selective estrogen-receptor modulators) and aromatase inhibitors as potential perioperative thrombotic risk factors in free flap breast reconstruction. Plast Reconstr Surg 2015; 135 (04) 670e-679e
    CrossrefPubMedGoogle Scholar
  • 43 Sanguigni V, Pignatelli P, Lenti L. , et al. Short-term treatment with atorvastatin reduces platelet CD40 ligand and thrombin generation in hypercholesterolemic patients. Circulation 2005; 111 (04) 412-419
    CrossrefPubMedGoogle Scholar
  • 44 Pršić A, Kiwanuka E, Caterson SA, Caterson EJ. Anticoagulants and statins as pharmacological agents in free flap surgery: current rationale. Eplasty 2015; 15: e51
    PubMedGoogle Scholar
  • 45 Karsenti G, Le Manach Y, Bouvier S, Chaine A, Bertolus C. Statins: a new pharmacological agent for free flap surgery?. J Plast Reconstr Aesthet Surg 2010; 63 (05) 870-874
    CrossrefPubMedGoogle Scholar
  • 46 Olsson E, Höijer P. Activated protein C resistance due to factor V Leiden, elevated coagulation factor VIII and postoperative deep vein thrombosis in late breast reconstruction with a free TRAM flap: a report of two cases. Br J Plast Surg 2005; 58 (05) 720-723
    CrossrefPubMedGoogle Scholar
  • 47 Handschin AE, Guggenheim M, Calcagni M, Künzi W, Giovanoli P. Factor V Leiden mutation and thrombotic occlusion of microsurgical anastomosis after free TRAM flap. Clin Appl Thromb Hemost 2010; 16 (02) 199-203
    CrossrefPubMedGoogle Scholar
  • 48 Khansa I, Colakoglu S, Tomich DC, Nguyen MD, Lee BT. Factor V Leiden associated with flap loss in microsurgical breast reconstruction. Microsurgery 2011; 31 (05) 409-412
    CrossrefPubMedGoogle Scholar
  • 49 Davison SP, Kessler CM, Al-Attar A. Microvascular free flap failure caused by unrecognized hypercoagulability. Plast Reconstr Surg 2009; 124 (02) 490-495
    CrossrefPubMedGoogle Scholar
  • 50 Herrera FA, Lee CK, Kryger G. , et al. Microsurgery in the hypercoagulable patient: review of the literature. J Reconstr Microsurg 2012; 28 (05) 305-312
    Article in Thieme ConnectPubMedGoogle Scholar
  • 51 Vandenbroucke JP, Koster T, Briët E, Reitsma PH, Bertina RM, Rosendaal FR. Increased risk of venous thrombosis in oral-contraceptive users who are carriers of factor V Leiden mutation. Lancet 1994; 344 (8935): 1453-1457
    CrossrefPubMedGoogle Scholar
  • 52 DeFazio MV, Economides JM, Anghel EL, Tefera EA, Evans KK. Lower extremity free tissue transfer in the setting of thrombophilia: analysis of perioperative anticoagulation protocols and predictors of flap failure. J Reconstr Microsurg 2018; 35 (04) 270-286
    Article in Thieme ConnectPubMedGoogle Scholar
  • 53 Chang DW. Breast reconstruction with microvascular MS-TRAM and DIEP flaps. Arch Plast Surg 2012; 39 (01) 3-10
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Spear SL, Ducic I, Cuoco F, Hannan C. The effect of smoking on flap and donor-site complications in pedicled TRAM breast reconstruction. Plast Reconstr Surg 2005; 116 (07) 1873-1880
    CrossrefPubMedGoogle Scholar
  • 55 Chang EI, Chang EI, Soto-Miranda MA. , et al. Evolution of bilateral free flap breast reconstruction over 10 years: optimizing outcomes and comparison to unilateral reconstruction. Plast Reconstr Surg 2015; 135 (06) 946e-953e
    CrossrefPubMedGoogle Scholar
  • 56 Chang DW, Reece GP, Wang B. , et al. Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction. Plast Reconstr Surg 2000; 105 (07) 2374-2380
    CrossrefPubMedGoogle Scholar
  • 57 Brands MT, van den Bosch SC, Dieleman FJ, Bergé SJ, Merkx MA. Prevention of thrombosis after microvascular tissue transfer in the head and neck. A review of the literature and the state of affairs in Dutch Head and Neck Cancer Centers. Int J Oral Maxillofac Surg 2010; 39 (02) 101-106
    CrossrefPubMedGoogle Scholar
  • 58 Sanati-Mehrizy P, Massenburg BB, Rozehnal JM, Ingargiola MJ, Hernandez Rosa J, Taub PJ. Risk factors leading to free flap failure: analysis from the national surgical quality improvement program database. J Craniofac Surg 2016; 27 (08) 1956-1964
    CrossrefPubMedGoogle Scholar
  • 59 Rozen WM, Ashton MW, Stella DL, Phillips TJ, Taylor GI. The accuracy of computed tomographic angiography for mapping the perforators of the DIEA: a cadaveric study. Plast Reconstr Surg 2008; 122 (02) 363-369
    CrossrefPubMedGoogle Scholar
  • 60 Mathes DW, Neligan PC. Preoperative imaging techniques for perforator selection in abdomen-based microsurgical breast reconstruction. Clin Plast Surg 2010; 37 (04) 581-591
    CrossrefPubMedGoogle Scholar
  • 61 Mossa-Basha M, Lee C. Impact of preoperative computed tomography angiogram on abdominal flap breast reconstruction outcomes: a systematic review. J Reconstr Microsurg 2017; 33 (05) 328-335
    Article in Thieme ConnectPubMedGoogle Scholar
  • 62 Casey III WJ, Chew RT, Rebecca AM, Smith AA, Collins JM, Pockaj BA. Advantages of preoperative computed tomography in deep inferior epigastric artery perforator flap breast reconstruction. Plast Reconstr Surg 2009; 123 (04) 1148-1155
    CrossrefPubMedGoogle Scholar
  • 63 Smit JM, Dimopoulou A, Liss AG. , et al. Preoperative CT angiography reduces surgery time in perforator flap reconstruction. J Plast Reconstr Aesthet Surg 2009; 62 (09) 1112-1117
    CrossrefPubMedGoogle Scholar
  • 64 Sergesketter AR, Pyfer BJ, Phillips BT, Zhao R, Hollenbeck ST. Check the record: remote CT scans for breast flap perforator mapping. J Reconstr Microsurg 2018; 34 (07) 485-491
    Article in Thieme ConnectPubMedGoogle Scholar
  • 65 Blackburn A, Taghizadeh R, Hughes D, O'Donoghue JM. Prevention of perioperative limb neuropathies in abdominal free flap breast reconstruction. J Plast Reconstr Aesthet Surg 2016; 69 (01) 48-54
    CrossrefPubMedGoogle Scholar
  • 66 Aronovitch SA. Intraoperatively acquired pressure ulcers: are there common risk factors?. Ostomy Wound Manage 2007; 53 (02) 57-69
    PubMedGoogle Scholar
  • 67 Burlingame BL. Guideline implementation: positioning the patient. AORN J 2017; 106 (03) 227-237
    CrossrefPubMedGoogle Scholar
  • 68 Phillips BT, Lanier ST, Conkling N. , et al. Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial. Plast Reconstr Surg 2012; 129 (05) 778e-788e
    CrossrefPubMedGoogle Scholar
  • 69 Giunta RE, Holzbach T, Taskov C. , et al. Prediction of flap necrosis with laser induced indocyanine green fluorescence in a rat model. Br J Plast Surg 2005; 58 (05) 695-701
    CrossrefPubMedGoogle Scholar
  • 70 Azuma R, Morimoto Y, Masumoto K. , et al. Detection of skin perforators by indocyanine green fluorescence nearly infrared angiography. Plast Reconstr Surg 2008; 122 (04) 1062-1067
    CrossrefPubMedGoogle Scholar
  • 71 Holm C, Mayr M, Höfter E, Becker A, Pfeiffer UJ, Mühlbauer W. Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg 2002; 55 (08) 635-644
    CrossrefPubMedGoogle Scholar
  • 72 Sacks JM, Nguyen AT, Broyles JM, Yu P, Valerio IL, Baumann DP. Near-infrared laser-assisted indocyanine green imaging for optimizing the design of the anterolateral thigh flap. Eplasty 2012; 12: e30
    PubMedGoogle Scholar
  • 73 Gurtner GC, Jones GE, Neligan PC. , et al. Intraoperative laser angiography using the SPY system: review of the literature and recommendations for use. Ann Surg Innov Res 2013; 7 (01) 1
    CrossrefPubMedGoogle Scholar
  • 74 Lindelauf AAMA, Vranken NPA, Schols RM, van der Hulst RRWJ. Tissue oximetry for monitoring free DIEP flap viability: factors to consider towards optimizing postoperative outcome. J Reconstr Microsurg 2018
    PubMedGoogle Scholar
  • 75 Hembd A, Teotia SS, Zhu H, Haddock NT. Optimizing perforator selection: a multivariable analysis of predictors for fat necrosis and abdominal morbidity in diep flap breast reconstruction. Plast Reconstr Surg 2018; 142 (03) 583-592
    CrossrefPubMedGoogle Scholar
  • 76 Casey III WJ, Connolly KA, Nanda A, Rebecca AM, Perdikis G, Smith AA. Indocyanine green laser angiography improves deep inferior epigastric perforator flap outcomes following abdominal suction lipectomy. Plast Reconstr Surg 2015; 135 (03) 491e-497e
    CrossrefPubMedGoogle Scholar
  • 77 Haynes AB, Weiser TG, Berry WR. , et al; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360 (05) 491-499
    CrossrefPubMedGoogle Scholar
  • 78 Ismail IK, Burns S, Rezak K, Adetayo O, Patel A, Agag R. Perioperative management for microvascular free tissue transfer: a pilot study examining the utility of a checklist in improving communication between microsurgeons and anesthesiologists. Plast Reconstr Surg 2015; 136 (4S): 151-152
    CrossrefPubMedGoogle Scholar
  • 79 Szabo Eltorai A, Huang CC, Lu JT, Ogura A, Caterson SA, Orgill DP. Selective intraoperative vasopressor use is not associated with increased risk of DIEP flap complications. Plast Reconstr Surg 2017; 140 (01) 70e-77e
    CrossrefPubMedGoogle Scholar
  • 80 Zhong T, Neinstein R, Massey C. , et al. Intravenous fluid infusion rate in microsurgical breast reconstruction: important lessons learned from 354 free flaps. Plast Reconstr Surg 2011; 128 (06) 1153-1160
    CrossrefPubMedGoogle Scholar
  • 81 Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand 1990; 34 (02) 144-155
    CrossrefPubMedGoogle Scholar
  • 82 Mlodinow AS, Khavanin N, Ver Halen JP, Rambachan A, Gutowski KA, Kim JY. Increased anaesthesia duration increases venous thromboembolism risk in plastic surgery: A 6-year analysis of over 19,000 cases using the NSQIP dataset. J Plast Surg Hand Surg 2015; 49 (04) 191-197
    CrossrefPubMedGoogle Scholar
  • 83 Weichman KE, Lam G, Wilson SC. , et al. The impact of two operating surgeons on microsurgical breast reconstruction. Plast Reconstr Surg 2017; 139 (02) 277-284
    CrossrefPubMedGoogle Scholar
  • 84 Bauermeister AJ, Zuriarrain A, Newman M, Earle SA, Medina III MA. Impact of continuous two-team approach in autologous breast reconstruction. J Reconstr Microsurg 2017; 33 (04) 298-304
    Article in Thieme ConnectPubMedGoogle Scholar
  • 85 Ehrl D, Heidekrueger PI, Ninkovic M, Broer PN. Impact of two attendings on the outcomes of microvascular limb reconstruction. J Reconstr Microsurg 2018; 34 (01) 59-64
    Article in Thieme ConnectPubMedGoogle Scholar
  • 86 Azzi AJ, Shah K, Seely A. , et al. Surgical team turnover and operative time: an evaluation of operating room efficiency during pulmonary resection. J Thorac Cardiovasc Surg 2016; 151 (05) 1391-1395
    CrossrefPubMedGoogle Scholar
  • 87 Zheng B, Panton ON, Al-Tayeb TA. Operative length independently affected by surgical team size: data from 2 Canadian hospitals. Can J Surg 2012; 55 (06) 371-376
    CrossrefPubMedGoogle Scholar
  • 88 Jubbal KT, Chang D, Izaddoost SA, Pederson W, Zavlin D, Echo A. Resident involvement in microsurgery: an American College of Surgeons National Surgical Quality Improvement Program Analysis. J Surg Educ 2017; 74 (06) 1124-1132
    CrossrefPubMedGoogle Scholar
  • 89 Young VL, Watson ME. Prevention of perioperative hypothermia in plastic surgery. Aesthet Surg J 2006; 26 (05) 551-571
    CrossrefPubMedGoogle Scholar
  • 90 Bindu B, Bindra A, Rath G. Temperature management under general anesthesia: compulsion or option. J Anaesthesiol Clin Pharmacol 2017; 33 (03) 306-316
    CrossrefPubMedGoogle Scholar
  • 91 Yi J, Xiang Z, Deng X. , et al. Incidence of inadvertent intraoperative hypothermia and its risk factors in patients undergoing general anesthesia in beijing: a prospective regional survey. PLoS One 2015; 10 (09) e0136136
    CrossrefPubMedGoogle Scholar
  • 92 Campbell G, Alderson P, Smith AF, Warttig S. Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. Cochrane Database Syst Rev 2015; (04) CD009891
    PubMedGoogle Scholar
  • 93 Liu YJ, Hirsch BP, Shah AA, Reid MA, Thomson JG. Mild intraoperative hypothermia reduces free tissue transfer thrombosis. J Reconstr Microsurg 2011; 27 (02) 121-126
    Article in Thieme ConnectPubMedGoogle Scholar
  • 94 Healey AN, Undre S, Vincent CA. Defining the technical skills of teamwork in surgery. Qual Saf Health Care 2006; 15 (04) 231-234
    CrossrefPubMedGoogle Scholar
  • 95 Rozen WM, Chubb D, Whitaker IS, Acosta R. The efficacy of postoperative monitoring: a single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps. Microsurgery 2010; 30 (02) 105-110
    CrossrefPubMedGoogle Scholar
  • 96 Smit JM, Werker PM, Liss AG. , et al. Introduction of the implantable Doppler system did not lead to an increased salvage rate of compromised flaps: a multivariate analysis. Plast Reconstr Surg 2010; 125 (06) 1710-1717
    CrossrefPubMedGoogle Scholar
  • 97 Schmulder A, Gur E, Zaretski A. Eight-year experience of the Cook-Swartz Doppler in free-flap operations: microsurgical and reexploration results with regard to a wide spectrum of surgeries. Microsurgery 2011; 31 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 98 Lin SJ, Nguyen MD, Chen C. , et al. Tissue oximetry monitoring in microsurgical breast reconstruction decreases flap loss and improves rate of flap salvage. Plast Reconstr Surg 2011; 127 (03) 1080-1085
    CrossrefPubMedGoogle Scholar
  • 99 Steele MH. Three-year experience using near infrared spectroscopy tissue oximetry monitoring of free tissue transfers. Ann Plast Surg 2011; 66 (05) 540-545
    CrossrefPubMedGoogle Scholar
  • 100 Goldberg J, Sepka RS, Perona BP, Pederson WC, Klitzman B. Laser Doppler blood flow measurements of common cutaneous donor sites for reconstructive surgery. Plast Reconstr Surg 1990; 85 (04) 581-586
    CrossrefPubMedGoogle Scholar
  • 101 Astanehe A, Temple-Oberle C, Nielsen M. , et al. An enhanced recovery after surgery pathway for microvascular breast reconstruction is safe and effective. Plast Reconstr Surg Glob Open 2018; 6 (01) e1634
    CrossrefPubMedGoogle Scholar
  • 102 Khouri RK, Cooley BC, Kunselman AR. , et al. A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg 1998; 102 (03) 711-721
    CrossrefPubMedGoogle Scholar
  • 103 Lighthall JG, Cain R, Ghanem TA, Wax MK. Effect of postoperative aspirin on outcomes in microvascular free tissue transfer surgery. Otolaryngol Head Neck Surg 2013; 148 (01) 40-46
    CrossrefPubMedGoogle Scholar
  • 104 Chien W, Varvares MA, Hadlock T, Cheney M, Deschler DG. Effects of aspirin and low-dose heparin in head and neck reconstruction using microvascular free flaps. Laryngoscope 2005; 115 (06) 973-976
    CrossrefPubMedGoogle Scholar
  • 105 Ashjian P, Chen CM, Pusic A, Disa JJ, Cordeiro PG, Mehrara BJ. The effect of postoperative anticoagulation on microvascular thrombosis. Ann Plast Surg 2007; 59 (01) 36-39 , discussion 39–40
    CrossrefPubMedGoogle Scholar
  • 106 Disa JJ, Polvora VP, Pusic AL, Singh B, Cordeiro PG. Dextran-related complications in head and neck microsurgery: do the benefits outweigh the risks? A prospective randomized analysis. Plast Reconstr Surg 2003; 112 (06) 1534-1539
    CrossrefPubMedGoogle Scholar
  • 107 Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon 2005; 51 (2-3): 70-78
    CrossrefPubMedGoogle Scholar
  • 108 Sultan SM, Jackson DS, Erhard HA. , et al. Risk factors for postoperative venous thromboembolic complications after microsurgical breast reconstruction. J Reconstr Microsurg 2018; 34 (04) 227-234
    Article in Thieme ConnectPubMedGoogle Scholar
  • 109 Tremblay DM, Harris PG, Gagnon AR, Cordoba C, Brutus JP, Nikolis A. Heparin-induced thrombocytopenia syndrome as a cause of flap failure: a report of two cases. J Plast Reconstr Aesthet Surg 2008; 61 (01) 78-83
    CrossrefPubMedGoogle Scholar
  • 110 Kim MJ, Woo KJ, Park BY, Kang SR. Effects of transfusion on free flap survival: searching for an optimal hemoglobin threshold for transfusion. J Reconstr Microsurg 2018; 34 (08) 610-615
    Article in Thieme ConnectPubMedGoogle Scholar