ПЕРІОПЕРАЦІЙНА ПРОФІЛАКТИКА УСКЛАДНЕНЬ ПРИ ВІЛЬНІЙ МІКРОХІРУРГІЧНІЙ ПЕРЕСАДЦІ КЛАПТЯ У ВІЙСЬКОВОСЛУЖБОВЦІВ

Background. Military personnel often suffer severe injuries that can lead to large soft tissue defects requiring complex surgical interventions. Free flap transplantation using microsurgical techniques is one of the main methods for repairing such defects. This makes the perioperative prevention of complications especially important, because the lack of proper control over the healing process can lead to thrombosis, infections, or rejection of the transplanted flap. Consideration of these factors in the peri and postoperative periods and proper planning for complication prevention are key to success. Aim. The aim of this study is to develop and improve methods of perioperative prevention of complications during free microsurgical flap transplantation in military personnel. This includes risk assessment, development of new approaches to patient preparation for surgery, as well as postoperative monitoring to reduce the likelihood of complications such as tissue necrosis, thrombosis and bleeding from the flap, infections, revascularization disorders, and others. Materials and methods. This study was conducted at the O.O. Shalimov National Scientific Center for Surgery and Transplantology. In the period from 2022 – 2nd quarter of 2024, 27 servicemen who had deep defects of soft tissues of the upper and lower limbs underwent a free microsurgical transplantation of a skin-muscle flap. Induction and maintenance doses of anesthetics and analgesics, body temperature in the peri- and postoperative period, use of vasopressors during this surgical intervention, etc.were analyzed. Six patients were experimentally calculated the HALP score according to the formula in the preoperative period to determine the risks of complications. Results. In 6 (22%) patients, HALP was evaluated preoperatively. Three patients had postoperative complications (thrombosis of the vascular pedicle and bleeding from the flap) – HALP score was <20. Anesthesiological provision of servicemen was carried out according to the scheme – general combined anesthesia with mechanical ventilation. Induction and maintenance doses of anesthetics and analgesics were more stable and varied depending on the patient's age and BMI. In 3 patients (11%) epidural analgesia was additionally performed perioperatively (Bupivacaine 0.25% at a dose of 10 mg/h with Fentanyl 0.005% – 2 μg /ml) continuous infusion. The dosage of IV Fentanyl 0.005% was 1.3 ± 0.1 μg/kg/h, while there were no repeated revisions of the flap. This type of multimodal analgesia improves flap microcirculation and significantly reduces the risk of postoperative complications. During anesthesia, 14 patients (52%) required vasopressor support. The priority of choice is norepinephrine, which does not affect the vascular pedicle and does not disturb the blood supply and trophic conditions of the transplanted flap, and in the perioperative period allows to keep the average blood pressure > 80 mm Hg. Also, one of the important factors is the patient's temperature. Hypothermia negatively affects the transplanted flap and increases the risk of postoperative complications. The body temperature of patients with complications and without repeated surgical interventions was 36.1±0.1 C0 and 36.4±0.1 C0, respectively, which indicates the negative effect of hypothermia. Conclusions. Perioperative prevention of complications during free microsurgical flap transplantation in military personnel is a key stage for successful surgeries and restoration of functional and aesthetic results. Important aspects include the use of regional anesthesia, vasopressor support, and normothermia of the patient during the perioperative period. HALP assessment, which can provide some information about the immunonutritional status of patients and predict peri- and postoperative complications. Another important aspect is to reduce the level of postoperative complications and ensure faster recovery of lost tissue function, which is especially important for military personnel who often have special requirements for recovery from injuries and surgeries. Studying these aspects can increase the effectiveness of treatment, improve the quality of life of patients and shorten the rehabilitation period. New methods of perioperative prevention of complications in free microsurgical flap transplantation should be further explored to reduce the risks and complication rates.