title: A novel approach for preventing the development of persistent vasospasms after microsurgery for the extremities: intermittent topical lidocaine application.
abstract: Vasospasm is often encountered after harvesting the recipient artery in tissue transfer surgery, particularly in the extremities. Further, after anastomosis, thrombosis is a major complication arising due to vasoconstriction. Therefore, we decided to apply lidocaine topically on the recipient artery to prevent postoperative vasospasm. We had applied lidocaine topically on the recipient artery in seven patients with persistent vasospasm before the completion of the surgery. After surgery, 0.2 mL lidocaine (4%) was directly applied on the vascularized region every 15 minutes for the first 3 hours, every 30 minutes for the next 3 hours, and every 1 hour for the next 18 hours. Although four patients experienced a disturbance in the blood flow immediately after the surgery, they showed improvements after lidocaine application. In three of these four patients, vasospasm was also suspected to occur at 15 minutes after the surgery; however, topical application of lidocaine was found to be effective in these patients. Thrombosis was not observed in any case. We believe that if the site of lidocaine application is appropriate, even a small dose of low-concentration lidocaine (4%) can produce an adequate effect. Moreover, the intervals between lidocaine applications should be carefully considered.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, Tokyo, Japan. yokotoshi0712@yahoo.co.jp
authors.forename: Toshiya
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Tosa
authors.forename: Koich
authors.initials: K
authors.lastname: Kadomatsu
authors.forename: Kaneshige
authors.initials: K
authors.lastname: Sato
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Hosaka
mesh_terms: D000287:Administration, Topical; D000714:Anastomosis, Surgical; D000779:Anesthetics, Local / Q000008:administration & dosage*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects*; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D000779:Anesthetics, Local; D014665:Vasodilator Agents; D008012:Lidocaine