RESUMO
Resumo Fundamento: O pós-operatório de cirurgia cardíaca valvar é desafiador devido ao risco de sangramento, levando a complicações e aumento da morbimortalidade. Objetivo: Desenvolver um escore de risco para prever hemorragia em pacientes no pós-operatório de cirurgia valvar. Métodos: Estudo retrospectivo de pacientes submetidos a cirurgia valvar entre 2021 e 2022 no IDPC. Pacientes com sangramento maior foram selecionados com base nos critérios de BARC e Bojar. Foi realizada uma análise de regressão logística para fatores relacionados ao sangramento e foi criado um nomograma. Para significância estatística, foram considerados p<0,05 e um intervalo de confiança de 95%. O estudo foi aprovado pelo CEP. Resultados: Foram analisados 525 pacientes com idade média de 56 anos e predomínio do sexo feminino. A valvopatia mais comum foi a insuficiência mitral, 8,8% apresentaram sangramento aumentado e houve 4,3% de reabordagens cirúrgicas. As variáveis com significância estatística foram: insuficiência tricúspide (OR 3,31, p < 0,001), doença renal crônica/lesão renal aguda (OR 2,97, p = 0,006), hemoglobina pré-operatória (OR 0,73, p < 0,001), reoperações (OR 2,5, p = 0,003), tempo de circulação extracorpórea (CEC) (OR 1,12, p < 0,001), abordagem de 2 valvas OR de 2,23 (p = 0,013), uso de concentrado de hemácias OR de 2,8 (p = 0,001). No modelo múltiplo a insuficiência tricúspide, tempo de CEC e hemoglobina pré-operatória alcançaram significância estatística. Conclusão: O tempo de CEC, hemoglobina pré-operatória e insuficiência tricúspide associaram-se independentemente com hemorragia pós-operatória. A escala proposta é plausível, e pode auxiliar na predição de risco de sangramento.
Abstract Background: The postoperative period of heart valve surgery is challenging due to the risk of bleeding, leading to complications and increased morbidity and mortality. Objective: To develop a risk score to predict bleeding in patients after valve surgery. Methods: Retrospective study of patients operated on between 2021 and 2022. Patients with major bleeding were selected based on the BARC and Bojar criteria. A logistic regression analysis was performed for factors related to bleeding and a nomogram of scores was created. For statistical significance, p<0.05 and a 95% confidence interval were considered. The study was approved by the CEP. Results: 525 patients were analyzed, with a mean age of 56 years and a predominance of females. The most common valve disease was mitral insufficiency, 8.8% had increased bleeding and 4.3% had surgical reoperations. The variables with statistical significance were tricuspid insufficiency (OR 3.31, p < 0.001), chronic kidney disease/acute kidney injury (OR 2.97, p = 0.006), preoperative hemoglobin (OR 0.73, p < 0.001), reoperations (OR 2, 5, p = 0.003), cardiopulmonary bypass (CPB) time (OR 1.12, p < 0.001), 2-valve approach OR of 2.23 (p = 0.013), use of packed red blood cells OR of 2.8 (p = 0.001). In the multiple model, tricuspid insufficiency, CPB time and preoperative hemoglobin reached statistical significance. Conclusion: CPB time, preoperative hemoglobin and tricuspid insufficiency were independently associated with postoperative bleeding. The proposed scale is plausible and can help predict the risk of bleeding.
RESUMO
BACKGROUND: Although a reliable procedure in morbid obesity treatment, bariatric surgery may be associated with serious complications such as leakage or bleeding. We aimed to analyze the preoperative factors involved in patients with early postoperative hemorrhage after any type of bariatric surgery who required conservative treatment or reoperation for this complication. METHODS: Retrospective case-controlled study (1:3) of 2 patient cohorts (postoperative bleeding/controls) matched by type of surgical intervention. RESULTS: Hypertension (Odds Ratio 5.029; 95% Confidence Interval 1.78-14.13) and history of antiplatelet medication (OR 13.263; 95% CI 1.39-125.9) were independent risk factors in the bivariate analyses, confirmed in the logistic regression model on multivariate analysis. CONCLUSIONS: With no between-group differences in Body Mass Index (BMI) and type 2 Diabetes (T2D), early hemorrhagic complications were found to be more frequent in patients with hypertension or antiplatelet drug treatment.
Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2 , Obesidade Mórbida , Cirurgia Bariátrica/efeitos adversos , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/complicações , Humanos , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
INTRODUCTION AND IMPORTANCE: Essential thrombocythemia (ET) is a myeloproliferative disorder characterized by increased platelet count and a high risk of bleeding or thrombotic events due to platelet dysfunction. Patients with ET are treated according to their risk of complications with cytoreductive or anti-aggregant treatment. Neither guidelines for oncologic patients nor perioperative management of patients with ET have been determined. CASE PRESENTATION: A 41-year-old female patient with ET who had alternating constipation and diarrhea was referred after a screening colonoscopy diagnosing a locally advanced rectosigmoid junction colon adenocarcinoma with liver metastases. Systemic preoperative chemotherapy was indicated. The patient underwent laparoscopic low anterior resection plus volume-preserving right lobectomy of the liver. Postoperative bleeding of the internal iliac artery (IIA) associated with hematoma at the lower pelvic cavity was diagnosed and treated by interventional radiology; the patient was discharged without other complications 16 days after surgery. CLINICAL DISCUSSION: ET has been related to the development of hematologic complications or second non-hematologic malignancies. A systematic review was conducted to seek guidance for the management of such patients in the perioperative period. Special perioperative care must be taken, and complications management should avoid further hemorrhages or cloth formation. CONCLUSION: Under oncologic and hematological guidance, minimally invasive surgery and non-invasive management of complications are advised in the lack of published perioperative management guidelines of ET patients with colorectal cancer.
RESUMO
Resumen: Todo procedimiento quirúrgico supone grados variables de agresión. La cirugía cardíaca (CC) con el uso muchas veces necesario de la circulación extracorpórea (CEC), impacta particularmente sobre múltiples sistemas orgánicos. En el presente trabajo, se analizará su repercusión sobre la hemostasia. El sangrado es una de las complicaciones más frecuentes y con mayor morbimortalidad durante el posoperatorio de CC. Aunque de causa multifactorial, adquieren especial relevancia la técnica quirúrgica, el tiempo de CEC y las enfermedades preexistentes. La aparición de nuevos fármacos procoagulantes y sistemas de monitorización de la hemostasia, junto al uso de protocolos de manejo con buena evidencia pero baja adherencia, no han logrado hasta el momento disminuir el uso de hemocomponentes. En esta revisión analizamos las recomendaciones actuales para el manejo del sangrado en CC, su prevención a través de la optimización preoperatoria del paciente, la estratificación del riesgo, el sostén de la hemostasia intraoperatoria y el tratamiento de las complicaciones hemorrágicas posoperatorias.
Summary: Any surgical procedure is detrimental to the body. Cardiac surgery with the necessary use of cardiopulmonary bypass particularly impacts on multiple systems. In this review, emphasis will be placed on its impact on hemostasis. Bleeding is one of the most frequent complications and with the highest morbidity and mortality in these patients. Although it is caused by a number of factors, the surgical technique, the cardiopulmonary bypass time and the pre-existing diseases acquire special relevance. The appearance of new procoagulant drugs and systems for monitoring hemostasis, the use of management protocols, with good evidence but low adherence, have so far not been able to reduce the use of blood components. In this review we analyse the current recommendations for the management of bleeding in cardiac surgery, its prevention through the preoperative optimization of the patient, stratify their risk, maintain intraoperative hemostasis and treat postoperative bleeding complications in those patients who suffer them.
Resumo: Todo procedimento cirúrgico envolve diferentes graus de agressão. A cirurgia cardíaca com o uso necessário da circulação extracorpórea impacta particularmente vários sistemas. Neste trabalho, será dada ênfase ao seu impacto na hemostase. O sangramento é uma das complicações mais comuns e mórbidas nesses pacientes. Embora mutifatorial na causa, a técnica cirúrgica, o tempo da circulação extracorpórea e as doenças pré-existentes tornam-se particularmente relevantes. O surgimento de novas drogas procoagulantes, novos sistemas de monitoramento de hemostase e o uso de protocolos de gestão com boas evidências mas baixa adesão até agora não conseguiram diminuir até agora o uso de hemocomponentes. Nesta revisão nós analisamos as recomendações atuais para o manejo do sangramento na cirurgia cardíaca, sua prevenção através da otimização pré-operatória do paciente, a estratificação do risco, o apoio da hemostase intraoperatória e o tratamento de complicações hemorrágicas pós-operatórias daqueles pacientes que os apresentam.
RESUMO
OBJECTIVES: A hemostasis management system (HMS) is a point-of-care method for heparin and protamine titration. The authors hypothesized that protamine dosing over the HMS estimate would be associated with elevated activated clotting time (ACT), increased bleeding, and transfusion owing to protamine's anticoagulant activity. DESIGN: A retrospective cohort study. SETTING: Single-center university hospital. PARTICIPANTS: One hundred eighty-nine patients undergoing elective coronary artery bypass grafting surgery. INTERVENTIONS: Patients were stratified into 3 groups per ratio of actual total administered protamine versus the HMS-derived protamine estimate: (1) low-ratio (≤66% of HMS estimate), (2) moderate-ratio (66%-100% of HMS estimate), and (3) high-ratio (>100% of HMS estimate). MEASUREMENTS AND MAIN RESULTS: The primary endpoints were post-protamine ACT, and residual heparin levels on HMS among the 3 groups in addition to bleeding and transfusion. There were 54 (28.6%) patients in the low, 95 (50.3%) in the moderate, and 40 (21.2%) in the high-ratio group. The high-ratio patients who were overdosed with protamine relative to the HMS estimate had elevated ACT, international normalized ratio, and activated partial thromboplastin time values, and subsequently received more red blood cell (RBC) and non-RBC transfusions compared to lower-ratio groups. Higher actual/HMS protamine ratios were associated independently with post-protamine ACT elevations after adjustment for sex, body mass index (BMI), and cardiopulmonary bypass (CPB) time. CONCLUSION: Most patients received the protamine dose sufficiently close to the HMS estimate, but protamine dosing above the HMS estimate occurred in both obese and nonobese patients, which was associated independently with prolonged ACT after adjusting for sex, BMI, and CPB time.
Assuntos
Anticoagulantes/administração & dosagem , Ponte de Artéria Coronária/tendências , Heparina/administração & dosagem , Protaminas/administração & dosagem , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/tendências , Estudos de Coortes , Ponte de Artéria Coronária/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito/tendências , Estudos RetrospectivosRESUMO
BACKGROUND: Hemorrhagic shock is a medical emergency that often complicates vascular surgery and can lead to death. Hemorrhagic shock is characterized by hypoperfusion and hemodynamic abnormalities leading to the collapse of homeostasis due to massive blood loss. Early diagnosis is critical for a favorable outcome. Thromboelastometry has been considered an effective tool for bleeding management in critically ill patients. Thromboelastometry can guide transfusion therapy quickly, reducing the need for blood products. Therefore, it could be an alternative test to guide hemostatic therapy in complex cases of hemorrhagic shock as a result of vascular surgeries. We report our successful experience with a case of hemorrhagic shock in postoperative care in vascular surgery, in which bleeding management was guided by thromboelastometry and bleeding control was achieved with hemostatic drugs and coagulation factor concentrates. CASE PRESENTATION: We report a case of an 82-year-old Afro-Brazilian man who presented to the intensive care unit with hemorrhagic shock in the postoperative period of vascular surgery. He underwent surgery for correction of iliac artery aneurysm with endoleak. His laboratory tests revealed severe anemia (hemoglobin 7.4 mg/dL), metabolic acidosis (bicarbonate 10 mEq/L, pH 7.11), acute kidney injury (creatinine 3.1 mg/dL), thrombocytopenia (platelets count 83 × 103/mm3), hypofibrinogenemia (70 mg/dL), international nationalized ratio 1.95, activated partial thromboplastin time 64.5 seconds, and lactate 87 mmol/L. There was active bleeding in surgical site. Bleeding management was guided by thromboelastometry. The first test showed fulminant hyperfibrinolysis, which was corrected with the administration of tranexamic acid. The second thromboelastometry test showed improvement of hyperfibrinolysis but severe hypocoagulability. Fibrinogen concentrate, platelet apheresis, cryoprecipitate, and prothrombin complex concentrate were sequentially administrated. Thromboelastometry was completely corrected after 2 hours. Arteriography to evaluate mechanical cause of bleeding was normal. No more bleeding was identified, and neither was any further transfusion needed. He was discharged from the intensive care unit from the ward 3 days after admission. CONCLUSIONS: Thromboelastometry may be considered a useful, feasible and safe tool to monitor and manage coagulopathy in patients with hemorrhagic shock. Moreover, it has the potential benefit of allowing rapid diagnosis, goal-directed therapy with hemostatic drugs and coagulation factor concentrates and thus, avoiding unnecessary blood component transfusion.
Assuntos
Tromboelastografia , Idoso , Idoso de 80 Anos ou mais , Alemanha , Hemostáticos , Humanos , Masculino , Qualidade de Vida , Choque Hemorrágico/terapiaRESUMO
ANTECEDENTES: El sangrado secundario es una de las principales causas de morbilidad después de la cirugía. El etamsilato se ha utilizado con buenos resultados para disminuir el sangrado en diversas patologías, como metrorragias, sangrado intraventricular, prostatectomías, cirugías de catarata y amigdalectomías. El objetivo de este estudio fue evaluar la efectividad del etamsilato para disminuir el sangrado en la cirugía de reemplazo total de cadera. MÉTODO: La población se dividió en dos grupos. En el grupo control se realizó la hemostasia de manera convencional; en el grupo experimental se administró etamsilato. RESULTADOS: Se incluyeron 34 pacientes, de los cuales 17 fueron aleatorizados al grupo de etamsilato y 17 al grupo control. No hubo diferencias en las características de la población entre los dos grupos. Al comparar los valores de hemoglobina preoperatoria y a las 24, 48 y 72 horas posquirúrgicas entre ambos grupos, no se encontraron diferencias estadísticamente significativas. Tampoco hubo diferencia en el hematocrito ni en la cuantificación del gasto por drenaje a las 24 y 48 horas. Hubo tres pacientes transfundidos en el grupo de etamsilato y siete en el grupo de control, lo cual no difirió significativamente (p = 0.62). CONCLUSIÓN: En este estudio no se demostró un efecto sobre la reducción de la hemorragia en pacientes sometidos a reemplazo total de cadera con el uso de etamsilato. BACKGROUND: Secondary bleeding is one of the leading causes of morbidity after the surgery. Ethamsylate has been used with good results to decrease bleeding in various pathologies such as metrorrhagia, intraventricular bleeding, prostatectomies, cataract surgeries and tonsillectomies. The objective of this study was to evaluate the effectiveness of the hemostatic agent ethamsylate to decrease bleeding in total hip replacement surgery. METHOD: The population were divided into two groups, in the control group was performed the hemostasis conventionally; in the experimental group ethamsylate was administered. RESULTS: A total of 34 patients were included, of whom 17 were randomized to the group of ethamsylate and 17 randomized to the control group. There were no differences in the characteristics of the population between the two groups. Comparing preoperative hemoglobin levels and at 24, 48 and 72 postsurgical hours between the control group and ethamsylate group there was no statistically significant difference. There was also no difference in the levels of hematocrit. In the quantification of expenditure by the drainage there was no difference between the groups at 24 and 48 hours. There were three patients transfused in the ethamsylate group and seven in the control group, which did not differ significantly (p = 0.62). CONCLUSION: An effect on the reduction of bleeding in patients undergoing total hip replacement with the use of hemostatic agent ethamsylate was not demonstrated in this study.
Assuntos
Artroplastia de Quadril , Transfusão de Sangue/estatística & dados numéricos , Etamsilato/uso terapêutico , Hemostáticos/uso terapêutico , Hemorragia Pós-Operatória/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Os retalhos interpolados têm sido um dos mais importantes e funcionais retalhos no arsenal da cirurgia plástica reconstrutiva, tornando-se uma opção segura mesmo nos casos mais difíceis. O pedículo do retalho interpolado necessita de curativo para evitar sangramento e a contaminação local. Este curativo frequentemente falha na prevenção de pequenos sangramentos que ocorrem durante as primeiras 24-48 horas, forçando a troca recorrente do mesmo, em média de três a cinco trocas. A técnica proposta neste trabalho consiste na aplicação direta de uma camada de GELFOAM®, envolto por gaze petrolizada, para prevenção do sangramento da área cruenta do pedículo do retalho, acarretando melhor hemostasia e menos manipulação do pedículo vascular.
Interpolated flaps are among the most important and functional flaps in reconstructive plastic surgery, representing a safe option even in the most difficult cases. The pedicle of the interpolated flap requires a dressing to avoid bleeding and local contamination. This dressing often fails to prevent minor bleedings, which occurs within the first 24-48 hours. As a result, it needs to be continuously changed, from three to five times on average. The technique proposed in this study consists in a direct application of a GELFOAM® layer. This is subsequently wrapped with petroleum gauze to prevent bleeding of the open area in the pedicle flap, improving hemostasis and reducing the manipulation of the vascular pedicle.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , História do Século XXI , Complicações Pós-Operatórias , Retalhos Cirúrgicos , Terapêutica , Bandagens , Hemorragia Pós-Operatória , Difusão de Inovações , Hemostasia , Hemostasia Cirúrgica , Complicações Pós-Operatórias/terapia , Retalhos Cirúrgicos/cirurgia , Terapêutica/métodos , Bandagens/efeitos adversos , Hemorragia Pós-Operatória/cirurgia , Hemorragia Pós-Operatória/terapia , Hemostasia/efeitos dos fármacos , Hemostasia Cirúrgica/métodosRESUMO
OBJECTIVE: To determine the clinical utility of hemoglobin level testing in guiding postoperative care following total laparoscopic hysterectomies performed for benign indications. STUDY DESIGN: Retrospective cohort study. RESULTS: A total of 629 women underwent total laparoscopic hysterectomies during the 24 month study period. Only 16 (2.5%) developed symptoms and/or signs suggestive of hemodynamic compromise. When compared to asymptomatic patients, symptomatic patients had a larger decrease in postoperative hemoglobin level (2.66 vs 1.80g/dL, P = .007) and were more likely to undergo blood transfusion, pelvic imaging or reoperation (P < .001). Women with a smaller body mass index and/or higher intraoperative intravenous fluid volume were more likely to have a larger decrease in postoperative hemoglobin level (P < .05). Past surgical history, duration and complexity of the hysterectomy, estimated surgical blood loss, uterine weight, and perioperative use of intravenous ketorolac were not associated with a greater decrease in postoperative hemoglobin (P > .05). Using the University of Pittsburgh Medical Center's annual laparoscopic hysterectomy rate and insurance companies' reimbursement for blood hemoglobin testing, we estimated the national annual cost for hemoglobin testing following total laparoscopic hysterectomy to be $2,804,662. CONCLUSION: Hemoglobin level testing has little clinical benefit following elective total laparoscopic hysterectomy and should be reserved for patients who develop signs or symptoms suggestive of acute anemia. Heath care cost savings can be substantial if this test is no longer routinely requested following total laparoscopic hysterectomies.
Assuntos
Hemoglobinas/análise , Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Cuidados Pós-Operatórios , Adulto , Índice de Massa Corporal , Estudos de Coortes , Redução de Custos , Feminino , Humanos , Histerectomia/economia , Laparoscopia/economia , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos RetrospectivosRESUMO
Introducción: Se reporta entre 1 por ciento y 6 por ciento de hemorragia posamigdalectomía y/o adenoidectomía. En la literatura se discute la real utilidad de los exámenes de hemostasia de rutina. Cuestionarios de sangrado estandarizados podrían definir a quién realizar un estudio de coagulación para predecir sangrados posamigdalectomía y/o adenoidectomía. Objetivo: Determinar la utilidad de un cuestionario preoperatorio para evaluar historia de sangrado y exámenes de coagulación rutinarios, para predecir sangrados asociados a amigdalectomía y/o adenoidectomía. Material y método: Se realizó un estudio prospectivo de cohorte, en el Servicio de Otorrinolaringología, Hospital Barros Luco. Se incluyeron pacientes sometidos a amigdalectomía y/o adenoidectomía, con cuestionario a menores de 18 años, entre enero de 2008 y junio de 2010. Se usó Chi cuadrado, Fisher, t de student según correspondiera para el análisis de los grupos. Se consideró estadísticamente significativo p <0,05. Resultados: Se revisaron 951 fichas de pacientes operados en el período de estudio, de un total de 1.288 cirugías (73,8(0) por ciento). Se excluyeron 65 por información incompleta y 272 sin cuestionario. Elpromedio (DE) de edad fue 7,70 +/-3,5 años (Rango: 1 -18 años). El 54 por ciento de los pacientes fue de sexo masculino. La frecuencia de sangrado fue 2,6 por ciento. La razón de proporciones (OR) para edad fue 1,11 (IC 95 por ciento 1,01-1,23); para amigdalitis crónica fue 2,56 (IC 95 por ciento 1,15-5,69). Los exámenes presentaron una sensibilidad de 4 por ciento y un valor de predicción positivo de 3 por ciento. El cuestionario de sangrado preoperatorio presentó una sensibilidad de 24 por ciento y un valor de predicción positivo de 3 por ciento. Discusión: El bajo valor de predicción positivo del cuestionario y los exámenes (3 por ciento) se asoció a la baja prevalencia de sangrado y otros factores involucrados en el sangrado posoperatorio. . .
Introduction: It is reported between 1percent and 6 percent of post-tonsillectomy hemorrhage and / or adenoidectomy. The literature discusses the real usefulness of routine hemostasis tests. Standardized questionnaires bleeding could define who make a study of post-tonsillectomy bleeding bleeding to predict and/or adenoidectomy. Aim: To determine the usefulness of a preoperative questionnaire to assess history of bleeding and routine coagulation tests to predict bleeding associated with tonsillectomy and/or adenoidectomy. Material and method: We performed a prospective cohort study in the Department of Otolaryngology, Hospital Barros Luco. We included patients undergoing tonsillectomy and / or adenoidectomy, with guest under 18 years between January 2008 and June 2010. We used chisquare, Fisher, Student t test as appropriate for the analysis of the groups. Statistical significance was p <0.05. Results: We reviewed 951 records of patients operated in the study period, a total of 1288 surgeries (73.8 percent). 65 were excluded due to incomplete information and 272 without questionnaire. The mean (SD) age was 7.70 + 3.5years (range: 1 to 18 years). 54 percent of patients were male. The frequency of bleeding was 2.6 percent. The ratio of ratios (OR) for age was 1.11 (95 percent C11.01 to 1.23) for chronic tonsillitis was 2.56 (95 percent C11.15 to 5.69). The tests showed a sensitivity of 4 percent and positive predictive value of 3 percent. The preoperative bleeding questionnaire had a sensitivity of 24 percent and positive predictive value of 3 percent. Discussion: The low positive predictive value of the questionnaire and examinations (3 percent) was associated with low prevalence of bleeding and other factors involved in postoperative bleeding. The questionnaire had a greaterability to detectpostoperative bleeding (24 percent). The use of the questionnaire represents a reliable tool that tests, but less expensive and less traumatic...
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adenoidectomia/efeitos adversos , Inquéritos e Questionários , Cuidados Pré-Operatórios/métodos , Hemorragia Pós-Operatória/epidemiologia , Tonsilectomia/efeitos adversos , Distribuição de Qui-Quadrado , Estudos Prospectivos , Estudos de Coortes , Hemorragia Pós-Operatória/prevenção & controle , Medição de Risco/métodos , Testes de Coagulação Sanguínea , Sensibilidade e Especificidade , Valor Preditivo dos TestesRESUMO
La osteotomía Le Fort I es un procedimiento rutinario en cirugía ortognática. Los autores reportan la ocurrencia de complicaciones intra y posquirúrgicas. La osteotomía Le Fort I está relacionada con gran variedad de complicaciones. Un conocimiento preciso de las complicaciones debería ayudar al cirujano, al ortodoncista y al paciente para estimar los beneficios de una cirugía electiva versus los riesgos. El conocer las complicaciones también debería ayudar a prevenir su ocurrencia y facilitar el tratamiento. El propósito de esta revisión fue reportar las complicaciones quirúrgicas y posquirúrgicas que están relacionadas con la osteotomía Le Fort I. Se presentan las complicaciones en el siguiente orden: oftalmológicas, vasculares, del seno cavernoso, necrosis avascular, edema, infecciosas, neurológicas, resultados estéticos desfavorables, cambios pulpares y otras complicaciones de rara ocurrencia.
Le Fort I osteotomy has become a routine procedure in elective orthognathic surgery. The authors report the occurrence of intra and post operative complications in Le Fort I osteotomy. The Le Fort I osteotomy is related to a variety of complications. A precise assessment of complications might be helpful for the patient, the orthodontist, and the surgeon in order to estimate the benefit of an elective operation versus its immanent risks. Knowledge of complications also might help to prevent their occurrence and facilitate their management. The aim of this review was to report the types and frequencies of intra and post operative complications related to Le Fort I osteotomy. This review presents surgical complications in the following order: Ophthalmic complications, Vascular complications, Cavernous sinus fistula, Ischemic complications including aseptic necrosis, swelling, significant infections such as abscesses or maxillary sinusitis, Nerve injures, unfavorable esthetic results, unfavorable pulpal reactions and other unusual complications.