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Protocolo de manejo perioperatorio de procedimientos microquirúrgicos en hospitales de concentración
Resumen
La microcirugía es una de las áreas más fértiles e innovadoras con las que cuenta la cirugía reconstructiva; los factores que han intervenido para lograr estos resultados son: el perfeccionamiento de la técnica quirúrgica, la adecuada selección de los pacientes y los minuciosos cuidados perioperatorios a los que son sometidos estos pacientes. Los cuidados perioperatorios comienzan desde la valoración inicial del paciente donde es muy importante considerar las indica- ciones y contraindicaciones de estos procedimientos. Recurrimos a este tipo de reconstrucción cuando nos enfrentamos a defectos complejos y/o extensos, que son difíciles o imposibles de reconstruir con otras técnicas. La profilaxis antibió- tica debe comenzar una hora antes de la incisión inicial. Los colgajos libres se clasifican como procedimientos con riesgo máximo para tromboembolismo venoso, por lo que es indispensable indicar una adecuada profilaxis. La normotermia, un adecuado manejo de líquidos, así como un uso juicioso de las transfusiones y de vasopresores son parte fundamental de los cuidados transoperatorios. La monitorización posquirúrgica de estos colgajos es fundamental para detectar tempranamente trombosis vascular y poder salvar el tejido transferido.
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