Keywords
Abstract
A rational anaesthetic approach in reconstructive and plastic surgery ensures adequate systemic hemodynamics and tissue perfusion, which contributes to good wound healing and has an important impact on the favourable outcome of the surgery. With this aim 56 patients aged 16 to 50 years old, who underwent skin plasty to eliminate post-burn contractures of the face, neck, and chest, were monitored. Surgical interventions were performed using different anaesthetic tactics: among 48.2% (27 patients) regional anaesthesia with cervical plexus and the third branch of the trigeminal nerve block was used, and among 51.8% (29 patients) reconstructive plastic surgery was performed under total intravenous anaesthesia with a combination of ketamine and fentanyl in age-appropriate dosages. Myoplegia was provided by using arduan. There were no anaesthesia-related complications during the surgery. Oxygen pressure in the soft tissues (PtcO2) of the operated area was studied using a Clark-type sensor by transcutaneous contact polarography. Central T1C (cheek area) and peripheral T2C (subclavian area) temperatures were recorded by electrical thermometry, as well as the temperature of the affected area T3C. Comparing the temperature gradients of the flaps at different stages of the perioperative period in different groups we found evidence of better microcirculation with regional anaesthesia than with total intravenous anaesthesia. The thermometry results did not contradict the values obtained during the first measurements, but only confirmed the assessment of the skin flap condition. This leads to fewer complications when using regional anaesthesia in the operated tissues compared to the use of other tested methods.