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Microsurgical reconstruction during the early puerperium
M Iglesias1, P Butrón, R Granados
1Department of Plastic Surgery, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico.
Journal of Reconstructive Microsurgery
|May 1, 1996
Summary
Reconstructing postpartum skin defects with a transverse rectus abdominis musculocutaneous free flap proved challenging due to severe vasospasm. Systemic papaverine exacerbated bleeding, leading to flap necrosis despite oxytocin use.
Area of Science:
- Plastic Surgery
- Obstetrics
- Vascular Surgery
Background:
- Postpartum reconstruction presents unique challenges due to physiological changes after childbirth.
- The transverse rectus abdominis musculocutaneous (TRAM) free flap is a reconstructive option, leveraging pregnancy-induced abdominal expansion.
Observation:
- During TRAM flap surgery 12 hours postpartum, significant vasodilation, bleeding, and severe arterial/venous spasm were noted.
- Local papaverine temporarily relieved spasm but vasospasm recurred upon contact with maternal blood.
- Systemic papaverine caused uterine vessel dilation and severe hemorrhage, necessitating its discontinuation.
Findings:
- Systemic papaverine administration led to uncontrolled uterine hemorrhage.
- Subsequent administration of systemic oxytocin resulted in decreased tissue perfusion.
- The TRAM flap experienced necrosis due to compromised blood flow.
Implications:
- The physiological state of early puerperium significantly impacts vascular responses during free flap surgery.
- Careful consideration of vasodilators and uterotonics is crucial to avoid complications like hemorrhage and flap necrosis.
- Alternative reconstructive strategies or modified perioperative management may be necessary for postpartum patients undergoing TRAM flap reconstruction.