title: Reconstructive surgery and patients with spinal cord injury: Perioperative considerations for the plastic surgeon.
abstract: BACKGROUND
  Patients with spinal cord injury (SCI) requiring reconstructive surgery, particularly for pressure ulcers, are ubiquitous in Plastic and Reconstructive Surgery practices. Much of the current literature focuses on operative techniques, antibiotic indications, sitting protocols, and dressing and bedding choices.
  
  
  METHODS
  This paper reviews normal neuroanatomy, outlines changes in neurophysiology observed in spinal cord injury, and addresses concepts related to perioperative care that are highly relevant but often under-emphasised.
  
  
  RESULTS
  Vascular disturbances such as autonomic dysreflexia and orthostatic hypotension are dangerous phenomena occurring in this patient population that, if not properly recognised and treated, may result in complications such as haematoma, flap loss, inadequate tissue perfusion, and death. The management of spasticity, deep venous thrombosis, and perioperative pain are also relevant and discussed in this paper.
  
  
  CONCLUSIONS
  A basic understanding of these concepts is essential for the Plastic Surgeon involved in the care of patients with SCI and pressure ulcers, particularly before and after debridement or reconstruction.
authors.affiliation: a Division of Plastic and Reconstructive Surgery , University of Wisconsin - Madison , Madison , WI , USA .
authors.forename: Jacqueline S
authors.initials: JS
authors.lastname: Israel
authors.affiliation: a Division of Plastic and Reconstructive Surgery , University of Wisconsin - Madison , Madison , WI , USA .
authors.forename: Anna R
authors.initials: AR
authors.lastname: Carlson
authors.affiliation: b Plastic Surgery Northwest , Spokane , WA , USA , and.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Bonneau
authors.affiliation: a Division of Plastic and Reconstructive Surgery , University of Wisconsin - Madison , Madison , WI , USA .
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Kempton
authors.affiliation: a Division of Plastic and Reconstructive Surgery , University of Wisconsin - Madison , Madison , WI , USA .
authors.forename: Timothy W
authors.initials: TW
authors.lastname: King
authors.affiliation: a Division of Plastic and Reconstructive Surgery , University of Wisconsin - Madison , Madison , WI , USA .
authors.forename: Michael L
authors.initials: ML
authors.lastname: Bentz
authors.affiliation: a Division of Plastic and Reconstructive Surgery , University of Wisconsin - Madison , Madison , WI , USA .|c Department of Surgery , Cairo University , Cairo , Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Afifi
mesh_terms: D020211:Autonomic Dysreflexia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D009128:Muscle Spasticity / Q000209:etiology / Q000517:prevention & control; D059408:Pain Management; D019990:Perioperative Care; D013119:Spinal Cord Injuries / Q000150:complications*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control
keywords: autonomic dysreflexia; neuropathic pain; pressure ulcer; reconstructive; spinal cord injury