Review Note
Last Update: 03/30/2025 11:01 PM
Current Deck: ACG Part 2::Plastic Surgery and Burns
New Card (Unpublished)Currently Published Content
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Commit #312127
SS_PB 1.4 Describe the common co-morbid disease and patient factors encountered in patients having plastic or reconstructive surgical procedures
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Commit #312127Patients undergoing plastic & reconstructive surgical procedures are of 2 broad groups:
- Young patients following major trauma – with large skin defects who have had prolonged hospitalization, issues with pain management, weight loss, nutrition, VTE, and who have issues of infection, wound breakdown.
- Elderly patients with big head and neck cancers – often heavy smokers, likely to have difficulty swallowing, are malnourished, and have significant comorbidities (such as IHD, COPD, peripheral vascular disease) that place them at substantial risk of cardiac decompensation. This risk is particularly high with the hyperdynamic circulation required to tolerate the operation and maintain graft perfusion over a long period of time, along with the pain, surgical stress, fluid loading, and blood loss.
- These patients often also have altered anatomy from radiotherapy/chemotherapy, which may lead to a difficult airway.
Factors to consider:
- Comorbidities affecting intra-operative management
- CVS : increased CVS risk
- Respiratory : COPD, asthma, OSA, smoking : prolonged ventilation , may require post operative monitoring
- Obesity/malnourished : careful pressure point monitoring.
- CKD - careful intra-operative fluid monitoring.
- Airway difficulty
- Head and neck cancer
- Prior radiotherapy
- Factors which complicate wound healing
- Poorly controlled diabetes
- Smoking
- Nutritional deficiencies
- Obesity