RESUMEN
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the mechanisms by which the three most common antithrombotic agents work. 2. Be familiar with accepted dosing levels for the three agents. 3. Understand the rationale for their use and formulate an algorithmic approach to microvascular thrombosis. Microsurgical anastomoses are largely technically dependent; however, there exists a finite rate of failure, with often devastating consequences. Pharmacologic prophylaxis and intervention are used extensively in microsurgical cases, yet a unified algorithm does not exist among the various basic science and clinical studies in the literature. This results in a confusing and nonstandardized practice based on anecdotal experiences. The purpose of this article is to review the literature on this topic and synthesize a practical clinical management algorithm for pharmacologic therapy in microsurgery.
Asunto(s)
Fibrinolíticos/uso terapéutico , Microcirugia , Trombosis/prevención & control , Procedimientos Quirúrgicos Vasculares , Anastomosis Quirúrgica , Animales , Anticoagulantes/uso terapéutico , Aspirina/uso terapéutico , Inhibidores de la Ciclooxigenasa/uso terapéutico , Dextranos/uso terapéutico , Heparina/uso terapéutico , Humanos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Colgajos Quirúrgicos/irrigación sanguíneaRESUMEN
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the epidemiology of skin cancer in a patient with preexisting skin cancer. 2. Understand the indications for the use of a nasolabial flap and nonanatomic alar strut graft. 3. Describe the blood supply to the nasolabial flap. The goals of reconstructing deformities of the face acquired secondary to skin tumors include optimizing donor-site aesthetics and reconstructing the area with similar types of tissue when possible. Multiple skin-cancer defects are often seen by the plastic surgeon and complicate the reconstruction, requiring more than one flap or skin graft. A case analysis of an innovative application of the nasolabial flap for reconstruction of a simultaneous medial cheek and alar-base nasal defect is presented. Concepts in nasal reconstruction are reviewed, and the authors' approach to alar reconstruction is presented.