Pre-operative assessment

Authors: Rami Mossad Ibrahim, Magnus Obinah, Magnus Balslev Avnstorp MD, Peter Stemann, Birgitte Jul Kiil and Christian Kaare Paaskesen Med. Stud.

It is important to do a proper full patient assesment from top to toe before surgery. This includes a profound assessment of specific anatomical region to be resected / trauma induced defect for useful recipient arteries and veins. Aswell as a profound assessment of donor site for skin quality and blood perfusion. A full set of blood samples including INR in case of blood thinning medication must also be preformed.

CT angiography must also be preformed to determine the exact location of the optimal perforating artery.

Depending on the case, different assessments must be made.

In case of carcinoma:

• Tumor location, size, bone involvement
• Nearby vessels for anastomosis
• Functional aspect i.e. when reconstructing tongue, CT scan or MR scan

In case of trauma:

• Size and depth of laceration
• Bone fractures
• Infection
• Nerve involvement
• Functional aspect i.e. reconstruction of breasts
• Nearby vessels for anastomosis

Also remember pre-operative information to patient, this includes placement of scares(depending on the specific perforator flap) as well as risk of infection, bleeding, hematoma, flap necrosis, seroma, swelling, change in shape and size, affection of donor- and recipient area.