Free tissue transfer in pregnancy: Guidelines for perioperative management

A successful free tissue transfer of serratus anterior muscle, to provide c overage for an open ankle defect in a pregnant patient, is described. Micro vascular surgery in the presence of a viable pregnancy demands consideratio ns unique to this situation. Although rarely possible, an attempt should be made to plan surgery to coincide with the second trimester, to lessen the risk of anesthesia to the fetus. Maternal positioning, fluid balance, and a spiration precautions need to be critically addressed. Close perioperative monitoring by an obstetrician is essential. The condition of pregnancy resu lts In a hypercoagulable state that may lead to an increased risk of anasto motic, failure. The use of anticoagulants results in increased risk of blee ding, not only for the patient but also for the fetus, as well as risk of t eratogenic effects. Closely monitored heparin is considered safe in pregnan cy as is low-molecular-weight dextran and low-dose aspirin. Additional cons iderations include the use of narcotics and sedatives for comfort postopera tively, as well as antibiotic choices, if Indicated. (C) 2001 Wiley-Liss, I nc.