[Perioperative drug management in surgery using revascularized flaps].

The success of free flap tissue transfer firstly depends on the correct surgical technique. Taking off from the donor site tissue for the reconstruction provokes a chain of physiopathological events that could evolve in truly pathological phenomena. The pharmacological treatment is aimed to miss and control the eventual local complication, and also to support the general conditions of the patient. Numerous pharmacological protocols have been proposed on experimental studies, and also on clinical practice to control local complications. It is necessary to eliminate the reactive vasospasm present in the vessels during anastomosis, and to reduce the risk of vascular pedicle thrombosis and to maintain rheological qualities of blood so to reactivate and sustain microcirculation functionality. Many authors have proposed anticoagulant and antiplatelet therapy, associated with vasodilatator drugs and drugs acting on blood viscosity and tissue metabolism, even if the latter have been primarily studied in experimental applications. The authors report their own experience on 29 patients that underwent 31 free flap tissue transfers from January 1992 to January 1995. The pharmacological therapy activated on the test can be divided into two different periods, one intraoperative and one postoperative. ASA is administered one hour before anastomosis, and vessels are irrigated with heparin or lidocaine solutions during the adventectomy and anastomosis. Antiplatelet therapy together with administration of low molecular dextran is performed in the first 3 to 4 postoperative days; afterwards, the dextran-40 administration is stopped while the ASA therapy is continued in smaller dose.