Serbest Flep ile Rekonstrüksiyon Uygulanan Hastalarda Koagülasyon Durumu ve Komorbiditelerin Flep Başarısına ve Komplikasyonlara Etkileri
Küçük Resim Yok
Tarih
2019
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Dergi ISSN
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Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Geniş defekti olan hastalarda serbest flep operasyonları rekonsrüktif cerrahinin temelini oluşturur. Bu hastalarda flep kaybına neden olan komplikasyonların önceden tahmin edilmesi hastanede kalış süresi ve maliyeti azaltma açısından çok önemlidir. Çalışmamızda hastaların koagülasyon durumlarının ve komorbiditelerinin flep kaybına ve komplikasyonlara olan etkilerini retrospektif olarak incelemeyi amaçladık. Yöntemler: Ocak 2015-Haziran 2017 tarihleri arasında serbest flep uygulanan hastaların preoperatif, intraoperatif ve postoperatif dönemdeki anestezi ve cerrahi kayıtlarından demografik verileri, sigara, alkol alışkanlıkları, yandaş hastalıkları, laboratuar tetkiklerinden koagülasyon testleri ve TEG (tromboelastogram) sonuçları geriye dönük olarak tarandı. Bulgular: Serbest flep uygulanan toplam 77 hastada flep başarı oranının %96,1; tromboz, hematom ve parsiyel nekroz gibi koagülasyonla ilişkili komplikasyon oranının ise %22,1 olduğu görüldü. Yaş, kronik obstrüktif akciğer hastalığı (KOAH) ve hiperkolesterolemi ile flep kaybı arasında anlamlı bir ilişki vardı (sırasıyla p=0,006, p=0,025 ve p=0,025). Flep komplikasyonlarının KOAH ve hipertansiyonu olan hastalarda daha sık görüldüğü belirlendi. Laboratuar tetkikleri incelendiğinde ise preoperatif ve postoperatif TEG ile flep komplikasyonları ve flep kaybı arasında istatistiksel bir ilişki saptanmadı. Ancak preoperatif INR’ nin hematom oluşumu ve flep kaybıyla, postoperatif aPTZ’nin ise sadece flep kaybı ile ilişkili olduğu görüldü. Sonuç: Serbest flep cerrahisinde ileri yaşın, hipertansiyon ve KOAH gibi yandaş hastalıkların komplikasyonlar ve flep kaybıyla ilişkili olduğu görüldü. Ancak koagülasyonu gösteren laboratuar tetkikleriyle komplikasyonlar ve flep kaybı arasında klinik açıdan anlamlı bir ilişki saptanamadı. Bu tür cerrahilerde koagülasyon testlerinin alınma zamanlarının ve postoperatif antikoagülan uygulamalarının standardize edilmesi gerektiği ve bu nedenle operasyona hazırlık, intraoperatif yönetim ve postoperatif takipler açısından standart protokollerin oluşturulması gerektiği düşüncesindeyiz.
Objective: Free flap surgeries constitute the basis of reconstruction surgery in patients with major defects. Prediction of complications that cause flap loss in such patients is important in terms of reducing the length of hospital stay and expenses. We aimed to retrospectively investigate the effect of co-morbidities and the coagulation status on flap loss and complications in patients with reconstructed free flap. Methods: Demographic data, smoking, alcohol habits, co-morbidities, coagulation tests and thromboelastogram results from preoperative, intraoperative and postoperative anaesthesia and surgical records of patients undergoing free flap surgeries between January 2015 and June 2017 were retrospectively screened. Results: Flap success rate was found to be 96.1% in total 77 patients with free flap. Coagulation related complication rate, such as thrombosis, haematoma and partial necrosis, were 22.1%. There was a significant relationship between age, chronic obstructive pulmonary disease and hypercholesterolaemia and flap loss (p=0.006, p=0.025 ve p=0.025, respectively). Flap complications were more frequent in patients with chronic obstructive pulmonary disease and hypertension. Laboratory test results revealed no statistical correlation between flap complications and flap loss with preoperative and postoperative TEG. Conclusion: Advanced age, co-morbidities such as hypertension and chronic obstructive pulmonary disease are associated with complications and flap loss in free flap surgery. However, there were no clinically significant association of complications and flap loss with laboratory tests showing coagulation. We believe that standardised protocols should be established in terms of preparation, intraoperative management and postoperative follow-ups because the time between taking the coagulation tests and postoperative anticoagulant administration should be standardised in such surgeries.
Objective: Free flap surgeries constitute the basis of reconstruction surgery in patients with major defects. Prediction of complications that cause flap loss in such patients is important in terms of reducing the length of hospital stay and expenses. We aimed to retrospectively investigate the effect of co-morbidities and the coagulation status on flap loss and complications in patients with reconstructed free flap. Methods: Demographic data, smoking, alcohol habits, co-morbidities, coagulation tests and thromboelastogram results from preoperative, intraoperative and postoperative anaesthesia and surgical records of patients undergoing free flap surgeries between January 2015 and June 2017 were retrospectively screened. Results: Flap success rate was found to be 96.1% in total 77 patients with free flap. Coagulation related complication rate, such as thrombosis, haematoma and partial necrosis, were 22.1%. There was a significant relationship between age, chronic obstructive pulmonary disease and hypercholesterolaemia and flap loss (p=0.006, p=0.025 ve p=0.025, respectively). Flap complications were more frequent in patients with chronic obstructive pulmonary disease and hypertension. Laboratory test results revealed no statistical correlation between flap complications and flap loss with preoperative and postoperative TEG. Conclusion: Advanced age, co-morbidities such as hypertension and chronic obstructive pulmonary disease are associated with complications and flap loss in free flap surgery. However, there were no clinically significant association of complications and flap loss with laboratory tests showing coagulation. We believe that standardised protocols should be established in terms of preparation, intraoperative management and postoperative follow-ups because the time between taking the coagulation tests and postoperative anticoagulant administration should be standardised in such surgeries.
Açıklama
Anahtar Kelimeler
Anestezi
Kaynak
Turkish Journal of Anaesthesiology and Reanimation
WoS Q Değeri
Scopus Q Değeri
Cilt
47
Sayı
2
