Microsurgery Health Article

Aftercare

Following surgery, the patient is given intravenous fluids and usually progresses to a liquid diet within 12 to 24 hours, and a regular diet soon thereafter. The patient must be kept warm and adequately hydrated, and the surgical site is elevated if possible to help drain excess fluids. Medications are administered to help manage pain. The color, temperature, quality of capillary refill, and tissue turgor (fullness) of the surgical site are closely monitored. Skin should be pink, warm, and have one- to two-second capillary refill. Conversely, tissue that is pale or blue, cool, with no refill or rapid refill may indicate a problem with blood flow.

Certain tests may be recommended to further evaluate the surgical site. These include:

• Doppler ultrasound. This technology uses high-frequency sound waves to evaluate the flow of blood to and from the surgical site.
• Intravenous fluorescein. After a chemical dye called fluorescein is administered to the patient, a specialized machine called a fluorimeter is used to determine how much blood is flowing through the surgical site.
• Pulse oximetry. A pulse oximeter measures the amount of oxygen in the blood and tracks the patient's pulse.
• Arteriography. X rays are taken of the surgical site after a contrast dye has been injected into the bloodstream to determine the condition of vascular anastomoses.

When the patient is discharged from the hospital, he or she will receive instructions for aftercare. Exposure to tobacco must be limited for at least six weeks following the surgery, as nicotine interferes with circulation. The patient must remain warm as body temperature also affects circulation. Bed rest may be prescribed for a period of days to weeks after surgery, depending on the procedure. Patients who have had a hand, finger, or multiple fingers replanted must keep the part elevated at heart level to help blood flow and decrease swelling.

Some form of rehabilitation is often recommended after microsurgery. This includes a program of individualized exercises used to restore function to a replanted or transplanted body part. In some cases where problems with circulation occur after surgery, leech therapy may be recommended. Leeches are worms that attach to the skin and draw blood while also injecting substances into the skin that act as a local anesthetic and an anticoagulant (preventing the formation of blood clots). Therapy involves attaching a leech to the replanted part or tissue flap and allow it to feed for 15 to 30 minutes, several times a day, until blood flow is established.

BOOKS

Jobe, Mark T. "Microsurgery" (Chapter 60). In Campbell's Operative Orthopedics, 10th ed. Philadelphia: Mosby, Inc., 2003.

ORGANIZATIONS

American Society for Reconstructive Microsurgery. 20 North Michigan Ave., Suite 700, Chicago, IL 60602. (312) 456-9579. <http://www.microsurg.org>.

OTHER

Buncke, Harry J. Microsurgery: Transplantation-Replantation. 2002 [cited April 25, 2003]. <http://buncke.org/book/contents.html>.

Chang, James. "Principles of Microsurgery." eMedicine. August 5, 2002 [cited April 25, 2003]. <http://www.emedicine.com/plastic/topic262.htm>.

"Microsurgery." California Pacific Medical Center. [cited April 25, 2003]. <http://www.cpmc.org/advanced/microsurg/>.

"Online Atlas of Microsurgery." Microsurgeon.org. March 20, 2003 [cited April 25, 2003]. <http://www.microsurgeon.org>.

Stephanie Dionne Sherk