scholarly journals Milrinone Does Not Improve Free Flap Survival in Microvascular Surgery

2007 ◽  
Vol 35 (5) ◽  
pp. 720-725 ◽  
Author(s):  
S. J. Jones ◽  
D. A. Scott ◽  
R. Watson ◽  
W. A. Morrison

Free flap microvascular surgery involves the transfer of a mobilised tissue flap with complete vascular reanastomosis at the new site. Ischaemia frequently threatens flap survival and may require a return to the operating theatre for anastomotic revision. Arterial spasm and hypoperfusion are recognised as factors in flap ischaemia. Phosphodiesterase inhibitors such as milrinone may improve flap blood flow and possibly flap survival by arterial dilation and increasing cardiac output. To investigate the role of milrinone in this type of surgery, a double-blinded randomised controlled trial was conducted with 88 patients receiving either a milrinone bolus and infusion throughout surgery or placebo (normal saline). We found that milrinone did not improve graft survival, return to theatre rate, or surgically graded arterial spasm, but did require more vasopressor support. We conclude that intraoperative milrinone did not improve flap outcomes in microvascular surgery.

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e051269
Author(s):  
Laura Koskenvuo ◽  
Pipsa Lunkka ◽  
Pirita Varpe ◽  
Marja Hyöty ◽  
Reetta Satokari ◽  
...  

IntroductionMechanical bowel preparation (MBP) prior to rectal surgery is widely used. Based on retrospective data many guidelines recommend mechanical and oral antibiotic bowel preparation (MOABP) to reduce postoperative complications and specifically surgical site infections (SSIs). The primary aim of this study is to examine whether MOABP reduces complications of rectal surgery.Methods and analysisThe MOBILE2 (Mechanical Bowel Preparation and Oral Antibiotics vs Mechanical Bowel Preparation Only Prior Rectal Surgery) trial is a multicentre, double-blinded, parallel group, superiority, randomised controlled trial comparing MOABP to MBP among patients scheduled for rectal surgery with colorectal or coloanal anastomosis. The patients randomised to the MOABP group receive 1 g neomycin and 1 g metronidazole two times on a day prior to surgery and patients randomised to the MBP group receive identical placebo. Based on power calculations, 604 patients will be enrolled in the study. The primary outcome is Comprehensive Complication Index within 30 days after surgery. Secondary outcomes are SSIs within 30 days after surgery, the number and classification of anastomosis dehiscences, the length of hospital stay, mortality within 90 days after surgery and the number of patients who received adjuvant treatment if needed. Tertiary outcomes are overall survival, disease-specific survival, recurrence-free survival and difference in quality-of-life before and 1 year after surgery. In addition, the microbiota differences in colon mucosa are analysed.Ethics and disseminationThe Ethics Committee of Helsinki University Hospital approved the study. The findings will be disseminated in peer-reviewed academic journals.Trial registration numberNCT04281667.


2017 ◽  
Vol 23 (1) ◽  
pp. 50-52 ◽  
Author(s):  
J. Mangwani ◽  
A. Gulati ◽  
R. Benson ◽  
M. Cichero ◽  
D.M. Williamson

2011 ◽  
Vol 9 (4) ◽  
pp. 397-402 ◽  
Author(s):  
Kamonwan Jenwitheesuk ◽  
Palakorn Surakunprapha ◽  
Kriangsak Jenwitheesuk ◽  
Chusak Kuptarnond ◽  
Sompop Prathanee ◽  
...  

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