bandage-green

Free Flap Reconstruction (DIEP / TRAM / ALT / Latissimus)

Anesthesia Implications

Clinically reviewed by anesthesia providers · Updated

Position : Supine, Lateral, arms tucked, arms extended, Bed turned 90 degrees, Bed turned 180 degrees
Time : 4+ hours (very long)
Blood Loss : High (200 - 500 ml)
Post-op Pain : Moderate (4-6)
Maintenance Paralytic : Ask Surgeon
Blocks : TAP, Rectus Sheath, PEC I, PEC II, Fascia Illiaca
Considerations : Arterial line, Central line, High Blood Loss, PONV, Tourniquet, Anticoagulation / Antiplatelet Therapy

Anesthetic Approaches

1GETT, Remifentanil Drip
2GETT, TIVA, Propofol Drip, Remifentanil Drip
3Nasal Rae, General, Nerve Block
The Surgery

Planning - Flap choice follows the defect. DIEP and TRAM take lower abdominal skin and fat for breast reconstruction; anterolateral thigh ( ALT ) and radial forearm cover head, neck, and extremity...

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