title: Guidelines for the optimization of microsurgery in atherosclerotic patients.
abstract: We review the pathogenesis of atherosclerosis and the issues that must be taken into consideration when performing microsurgery in atherosclerotic patients. Atherosclerosis is a systemic disease, and may affect the success of microsurgery. Atherosclerotic patients have a tendency toward thrombosis, because the nature of the arteries is changed. Such patients are usually old and have additional medical problems. To increase the success rate of microsurgery in atherosclerotic patients, special precautions should be considered. Patients must be evaluated properly for the suitability of microsurgery. The microsurgical technique requires a meticulous approach, and various technical tricks can be used to avoid thrombosis. Recipient-vessel selection, anastomotic technique, and the use of vein grafts are all important issues. Prophylactic anticoagulation is recommended in severely atherosclerotic patients. Close monitoring of the patient and flap is necessary after the operation, as with routine microvascular free-tissue transfers. We conclude that atherosclerosis is not a contraindication for microsurgery. If the microsurgeon knows how to deal with the difficulties in atherosclerotic patients, microsurgery can be performed safely.
authors.affiliation: Department of Plastic and Reconstructive Surgery, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan, Republic of China. Mardinis@aol.com
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
authors.forename: O Koray
authors.initials: OK
authors.lastname: Coskunfirat
authors.forename: Omer
authors.initials: O
authors.lastname: Ozkan
authors.forename: Samir
authors.initials: S
authors.lastname: Mardini
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cigna
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Salgado
authors.forename: Stefano
authors.initials: S
authors.lastname: Spanio
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D050197:Atherosclerosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D018579:Patient Selection; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D013524:Surgical Flaps / Q000098:blood supply*; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000592:standards*
chemical_list: D000925:Anticoagulants