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Prevention of perioperative limb neuropathies in abdominal free flap breast reconstruction

Lookup NU author(s): David Hughes, Joseph O'Donoghue

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Abstract

Background and aims: Perioperative peripheral neuropathies are a significant cause of post-operative morbidity in patients undergoing prolonged procedures. The aims of this study were to determine the incidence and possible causes of peripheral neuropathy in patients undergoing abdominal free flap breast reconstruction and to develop methods of ameliorating this problem.Methods: A 4-year retrospective study of patients undergoing abdominal free flap breast reconstruction by a single surgeon and anaesthetist was undertaken to determine the incidence and potential causes of perioperative neuropathy. A new positioning protocol was introduced to minimise the stretch on the brachial plexus and to protect peripheral nerves from compression forces. In addition, regular intraoperative physiotherapy was introduced.A prospective study was then conducted on patients managed by the same team to evaluate the effect of this change in practice on the subsequent incidence of peripheral neuropathies. Results: Over the 4-year retrospective period, 93 consecutive patients underwent abdominal free flap breast reconstruction, six of whom (6.5%) developed a peripheral neuropathy. Following the introduction of the new positioning protocol, prospective data collected on 65 consecutive patients showed no further occurrences of perioperative neuropathy (p = 0.04). There were no significant differences in the characteristics between the two cohorts.Conclusion: Perioperative peripheral neuropathy in abdominal free flap breast reconstruction is a preventable problem. This paper presents a peripheral neuropathy prevention protocol for managing these patients. (C) 2015 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.

Publication metadata

Author(s): Blackburn A, Taghizadeh R, Hughes D, O'Donoghue JM

Publication type: Article

Publication status: Published

Journal: Journal of Plastic, Reconstructive & Aesthetic Surgery

Year: 2016

Volume: 69

Issue: 1

Pages: 48-54

Print publication date: 01/01/2016

Online publication date: 19/10/2015

Acceptance date: 24/09/2015

ISSN (print): 1748-6815

ISSN (electronic): 1878-0539

Publisher: Elsevier

URL: http://dx.doi.org/10.1016/j.bjps.2015.09.015

DOI: 10.1016/j.bjps.2015.09.015

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