title: Free tissue transfer in pregnancy: guidelines for perioperative management.
abstract: A successful free tissue transfer of serratus anterior muscle, to provide coverage for an open ankle defect in a pregnant patient, is described. Microvascular surgery in the presence of a viable pregnancy demands considerations unique to this situation. Although rarely possible, an attempt should be made to plan surgery to coincide with the second trimester, to lessen the risk of anesthesia to the fetus. Maternal positioning, fluid balance, and aspiration precautions need to be critically addressed. Close perioperative monitoring by an obstetrician is essential. The condition of pregnancy results in a hypercoagulable state that may lead to an increased risk of anastomotic failure. The use of anticoagulants results in increased risk of bleeding, not only for the patient but also for the fetus, as well as risk of teratogenic effects. Closely monitored heparin is considered safe in pregnancy as is low-molecular-weight dextran and low-dose aspirin. Additional considerations include the use of narcotics and sedatives for comfort postoperatively, as well as antibiotic choices, if indicated.
authors.affiliation: Section of Plastic Surgery, Medical College of Georgia, Augusta, Georgia, USA.
authors.forename: G R
authors.initials: GR
authors.lastname: Meger
authors.forename: W T
authors.initials: WT
authors.lastname: Majewski
authors.forename: W G
authors.initials: WG
authors.lastname: Lyle
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005360:Fibula / Q000293:injuries / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D005597:Fractures, Open / Q000150:complications / Q000601:surgery*; D017408:Guidelines as Topic; D006801:Humans; D009104:Multiple Trauma; D018482:Muscle, Skeletal / Q000637:transplantation*; D010019:Osteomyelitis / Q000175:diagnosis / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery*; D011859:Radiography; D018570:Risk Assessment; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000601:surgery; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*