Perioperative Care of the Surgical Patient: Reconstructive Surgery
Journal Title
In: Hagberg, C.A., Gottumukkala, V.N.R., Riedel, B.J., Nates, J.L., Buggy, D.J. (eds) Perioperative Care of the Cancer Patient
Publication Type
Book section
Abstract
Autologous free flap reconstructive surgery has become an integral part of surgical oncology. It allows for more aggressive and definitive resection of solid tumors and the repair of defects left by nonsurgical therapies. Current anesthetic practice is variable, reflecting a paucity of high-level evidence guiding best practice in this field. Despite this, flap surgery outcomes have continued to improve, with success rates of greater than 95% reported. Applied surgical and pathophysiologic concepts relevant to flap surgery are covered in this chapter. There is particular focus on the identification and optimization of risk factors implicated in poor patient outcomes. The relevance of the endothelial glycocalyx is a pivotal concept for flap pathophysiology and is an evolving point of interest. Research into the degradation of this endovascular layer may provide further understanding of complications, including flap failure, at a pathophysiologic level. This, in turn, may determine future directions for anesthetic management.
Publisher
Elsevier
Keywords
Breast reconstruction; endothelial glycocalyx; ERAS; free flap; head and neck reconstruction; microvascular tissue transfer; oncosurgery; perioperative medicine
Department(s)
Anaesthetics
Terms of Use/Rights Notice
Refer to copyright notice on published article.


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