[Value of hemodilution in maxillofacial surgery for postoperative traumatic edema and graft viability]

The effects were studied of normovolaemic haemodilution on postoperative traumatic oedema after surgical repair of craniofacial disjunction (CFD) and on pedicle graft viability after excision of squamous carcinomas of the floor of the mouth (CFM). Fourty patients were studied: twenty operated on for CFD and twenty for CFM. These patients were randomly assigned to the treated or the control groups. The treated ones were operated on under moderate normovolaemic haemodilution induced with a colloid solution (Plasmion). The subsequent haematocrits were 0.29 +/- 0.01 for the CFD group and 0.30 +/- 0.02 for the CFM group. The biometric parameters and the length of the surgical procedures were comparable for the two series. Operative blood loss was less in the treated series (p less than 0.001 for the CFD group and p less than 0.01 for the CFM group), thus needing less blood transfusion (p less than 0.001). The postoperative oedema in the treated CFD series was less (p less than 0.001), although the oncotic pressure and the plasma osmolality were decreased in this series (p less than 0.05). On the other hand, viscosity in the hemodiluted series was significantly decreased in comparison with the control series (p less than 0.001). Graft viability was significantly improved in the treated series (p less than 0.05). Thus, normovolaemic haemodilution was a very useful adjunct in plastic and reconstructive surgery of the face and the mouth. This technique had three advantages: reduction of postoperative traumatic oedema after CFM repair, graft viability improvement after mouth carcinoma excision and blood saving in both procedures.