Free

ap in the ICU

ICU
201631
3

1.(free ap)
2.

3.
4.

5.
6.

amputa<on
1.(free ap)

(ap)

()


()

1.
2.

3.
4.
5.



()


1.
(groin ap)
(bular ap)

2.
(sacapular ap)
(forearm ap)
(anterolateral thigh(ALT) ap)

3.
(rectus abdominis musculocutaneous ap)
(la<ssimus dorsi musculocutaneous ap)
(gracilis muscle ap)
(serratus anterior ap)

()

 J Oral Maxillofac Surg 2015;73(4):786.e1-11

//
(DCIA)/
(ALT)




etc.

etc.

etc.

etc.

etc.
ENT Now Treatment and Surgery No.4
()











()
CV

()
2009;52(2):135-41













ENT Now Treatment and Surgery No.4
()

ENT Now Treatment and Surgery No.4
()


J Oral Maxillofac Surg 2014;72(9):1832-40

20007201112

1(Larry L. Myers)
n=121


Very Large Area(200cm2)n=38(31%)
Large Area(100199cm2)n=83(69%)

 (SCC)


Very Large Area7.6(95%CI;
5.7-10.0)
Large Area8.4(95%CI;5.4-12.9)
(P=0.376)

Very Large AreaLarge Area
ap failure
ICUVery Large Area

()
14%
Plast Reconstr Surg 2015;135(4):1124-39.

()
365%
Arch Otolaryngol Head Neck Surg 2006;132(1):67-72


46%
ANZ J Surg 2008;78(5):383-8

ap failure(ap loss)
(par<al)(total)
2.


Inn Anesthesiol Clin 1998;36(3):21-9

()


2372

J Reconstr Microsurg 2003;19(6):363-8

Plast Reconstr Surg 2012;129(4):730e-1e


Plast Reconstr Surg 2014;134(6):1323-32

20062011American College of Surgeons Na<onal Surgical
Quality Improvement Program(ACS-NSQIP)


(n=1302)(n=1123)



13

BMI

ASA
or




()
<3.0g/dL(4.31;P<0.0001)

 Acta Otorhinolaryngol Ital 2014;34(6):389393

20101201212
n=84

par<al ap loss15total ap loss231

()
 Head Neck 2007;29(12):1090-101

19999200110
n=185


n=98(53%)
n=68n=74n=63

ASA and
(>130 mL/kg/24 h)




2011;54:1389-96

Plast Reconstr Surg 1997;99(1):156-62

Surgery Fron<er 2000;7:42-4


2013;56(5):497504

Laryngoscope 2010;120(4):717-23

3.
 PLoS One 2016;11(2):e0147713

20121201310
n=181


TIVA()Inhala<on()

TIVA


:TIVA vs Inhala<on 18 vs 47 (p=0.0008)

TIVA
(0.41;95%CI.0.180.92)

Head Neck 2016:10.1002/hed.24362

MAP>75mmHg



n=94
vs (MAP>70 or baseline20%)
ICU33.7(n=47) vs 58.3(n=47) (p=0.026)
ap failure
 Plast Reconstr Surg 2015;136(2):411-22

20


145







(1248101220%)





E1





 Plast Reconstr Surg 2015;135(4):1124-39

(
)12


210
n=4984

:ap loss35%
(0.65; 95%CI,1.69-0.25)
ap failure


(1.91;95%CI,1.05-3.47)

6
total ap loss
(1.78;95%CI,1.20-2.63)


ap survival

total ap failure


 J Oral Maxillofac Surg 2015;73(6):1065-72

PACUn=80

DEX()10.5mg/kg/
hPACU0.20.7mg/kg/h
()
5

38.5% vs 45%(P=0.029)
5.1% vs 12.5%(P=0.432)

DEX
ICU
4.

610()
ICU

ivPCAPICC


(
)

DEX
ICU


2
ICU
()PIMS



110mmHg<SBP()<160mmHg
Hb>10
30



25

5
200013273-7

()

 ANZ J Surg 2008;78(5):383-8

2001220062
132
6

27(21.4%)


NSAIDs

vs
SBP() 115 vs 121 mmHg(p=0.036)
1SBP 147 vs 161 mmHg(p=0.0067)
 Eur Arch Otorhinolaryngol 2013;270(1):173-9


2006820115n=36


Preopera<ve hemoglobin<12.2 g/dL4.955(1.6459.266)
Postopera<ve hemoglobin<12.2 g/dL3.653(1.4596.848)
Postopera<ve albumin<3.5 g/dL3.230(1.0544.090)

capillary relling test

1996;21(1):8-13





pin prick test

1996;21(1):8-13


J Reconstr Microsurg 1990;6:363-6


1.
2.
3.

Plast Reconstr Surg 2007;119(7):2092-100

 Plast Reconstr Surg 2007;120(1):187-95

2002/1/12003/6/30

the microsurgical intensive care unit5
n=1142
(n=685)(n=392)(n=65)

113(9.9%)


2493
(82.3%)
5

564.5%21.3%14.8%
 J Reconstr Microsurg 2013;29(7):473-79


20011200812
n=170
38.5%30.2%
31.3%

Vascularetc.
8.9%(n=16)
Nonvascularetc.
11.7%(n=21)


2448Vascular72Nonvascular

72ICU12


ICU


HbAlb

DEXICU



(ASA)HbAlb
TIVA
SBP120mmHg

SBP160mmHg
5


5.


()

2014;33(6):624-29



3.511.1%
1520%

2014;57(12):1349-58

J Oral Maxillofac Surg 2015;73(8):1637-40

 Plast Reconstr Surg 2013;132(3)591-6

(72)

1995120111215



emergent(<24)early (<5)primary (621)
delayed (>21)
ap failure

 Plast Reconstr Surg 2013;132(6):1733-41
amputa<on

J Trauma 2000;48:913917

J Bone Joint Surg Am 2000;82:16811691

(perforator ap)



6.


(30)

5060

2
 Plast Reconstr Surg 2013;131(5):827e-36e


ICU

ICU










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