Acute pulmonary edema after microsurgery: two case reports

Postoperative management procedures after microsurgery are well-established. Usually, maintaining an adequate plasma volume will lower blood viscosity and will provide an adequate arterial inflow to keep the replantation or the flap viable in routine microsurgical procedures. But if the patient's underlying condition is neglected, disasterous complications may occur. The authors report two cases with severe postoperative complications after microsurgery. One patient was a 38-year-old male who suffered from diabetic foot ulcer and received a free muscle flap transfer. He developed acute pulmonary edema at day 6 postoperatively. The other patient was a 20-year-old pregnant woman at 31 weeks gestation who developed pulmonary edema on the POD 4 following microsurgical replantation of the thumb and index finger of her left hand. The complications were believed to be caused by fluid overload and neglect of the patients' underlying conditions. Knowledge of possible precipitating factors and careful monitoring of fluid should avoid acute pulmonary edema after microsurgery under certain unusual conditions.