Patient Blood Management in Microsurgical Procedures for Reconstructive Surgery

Area of Science:

• * Reconstructive Surgery
• * Anemia Management
• * Microsurgery

Background:

• * Reconstructive surgery (RS) aims to restore tissue integrity after trauma, surgery, or congenital deformities.
• * Microsurgical techniques involve flap transfer with vascular anastomosis, influenced by preoperative modifiable factors.
• * Anemia, particularly anemia of chronic disease (ACD), is common post-RS and impacts flap viability.

Purpose of the Study:

• * To present a therapeutic protocol for managing anemia in reconstructive surgery patients.
• * To reduce the need for blood transfusions by optimizing hemoglobin levels and organ perfusion.
• * To assess the efficacy and safety of ESAs and intravenous iron in post-RS anemia.

Main Methods:

• * A protocol involving erythropoietic stimulating agents (ESAs) and intravenous iron was applied to 16 male patients (mean age 38) undergoing microsurgical RS.
• * Patients received ESAs (Binocrit 6000 UI/week) and either ferric carboxymaltose (FCM) or iron gluconate intravenously.
• * Hemoglobin, corpuscular indexes, transferrin saturation (TSAT), ferritin, and creatinine clearance were monitored at T0, T1, and T2 post-surgery.

Main Results:

• * All 16 patients received the treatment protocol without requiring blood transfusions.
• * No adverse side effects or instances of limb or flap rejection were reported.
• * Preliminary data indicate an optimal therapeutic response to the anemia management protocol.

Conclusions:

• * The developed therapeutic protocol demonstrates an effective approach to managing anemia in reconstructive surgery.
• * The protocol successfully avoided blood transfusions and flap complications in the study cohort.
• * Further patient enrollment is recommended to validate these findings with statistically significant data.