THE INFLAMMATORY REACTION IN ELECTIVE FLAP SURGERY

The inflammatory response in three different flap procedures was inves tigated by measuring the preoperative and postoperative levels of C-re active protein, leukocyte count, and body temperature. Patients schedu led for delayed breast reconstruction were operated on with the latera l thoracodorsal flap, the latissimus dorsi flap, or the pedicled TRAM flap. All patients received 2 gm of intravenous cloxacillin for antibi otic prophylaxis and 1 gm of paracetamol four times a day as basic tre atment for postoperative pain. Within each treatment group, significan t postoperative changes in C-reactive protein levels, leukocyte count, and body temperature were noted when compared with preoperative value s. The highest C-reactive protein level (130 mg/ml) was found in the T RAM group on the third postoperative day. The kinetic pattern of C-rea ctive protein was similar for the latissimus dorsi flap and lateral th oracodorsal flap procedures, but the maximum C-reactive protein levels were significantly lower, 74 and 44 mg/ml respectively. Small (0.5 to 0.9 degrees C) but significant differences in body temperature were a lso noted on the second and third postoperative day. The TRAM flap gro up had the highest, the latissimus dorsi flap group intermediate, and the lateral thoracodorsal flap group the lowest value. The postoperati ve C-reactive protein levels seem to reflect the extent of the surgica l trauma.