Abstract：
Microsurgical free tissue transfer has been successfully implemented for various reconstructive applications in children. The goal of this study was to identify the best available evidence on perioperative management of pediatric patients undergoing free tissue transfer and to use it to develop evidence-based care guidelines.
A systematic review was conducted in the PubMed, Embase, Scopus, and Cochrane Library databases. Because a preliminary search of the pediatric microsurgical literature yielded scant data with a low level of evidence, pediatric anesthesia guidelines for healthy children undergoing major operations were also included. Exclusion criteria included vague descriptions of perioperative care, case reports, and studies of syndromic or chronically ill children.
Two hundred four articles were identified, and 53 met inclusion criteria. Management approaches specific to the pediatric population were used to formulate recommendations. High-quality data were found for anesthesia, analgesia, fluid administration/blood transfusion, and anticoagulation (Level I Evidence). Lower quality evidence was identified for patient temperature (Level III Evidence) and vasodilator use (Level IV Evidence). Key recommendations include administering sevoflurane for general anesthesia, implementing a multimodal analgesia strategy, limiting preoperative fasting, restricting blood transfusions until hemoglobin level is less than 7 g/dl unless the patient is symptomatic, and reserving chemical venous thromboembolism prophylaxis for high-risk patients.
Pediatric-specific guidelines are important, as they acknowledge physiologic differences in children, which may be overlooked when extrapolating from adult studies. These evidence-based recommendations are a key first step toward standardization of perioperative care of pediatric patients undergoing plastic surgical procedures, including free tissue transfer, to improve outcomes and minimize complications.
A systematic review was conducted in the PubMed, Embase, Scopus, and Cochrane Library databases. Because a preliminary search of the pediatric microsurgical literature yielded scant data with a low level of evidence, pediatric anesthesia guidelines for healthy children undergoing major operations were also included. Exclusion criteria included vague descriptions of perioperative care, case reports, and studies of syndromic or chronically ill children.
Two hundred four articles were identified, and 53 met inclusion criteria. Management approaches specific to the pediatric population were used to formulate recommendations. High-quality data were found for anesthesia, analgesia, fluid administration/blood transfusion, and anticoagulation (Level I Evidence). Lower quality evidence was identified for patient temperature (Level III Evidence) and vasodilator use (Level IV Evidence). Key recommendations include administering sevoflurane for general anesthesia, implementing a multimodal analgesia strategy, limiting preoperative fasting, restricting blood transfusions until hemoglobin level is less than 7 g/dl unless the patient is symptomatic, and reserving chemical venous thromboembolism prophylaxis for high-risk patients.
Pediatric-specific guidelines are important, as they acknowledge physiologic differences in children, which may be overlooked when extrapolating from adult studies. These evidence-based recommendations are a key first step toward standardization of perioperative care of pediatric patients undergoing plastic surgical procedures, including free tissue transfer, to improve outcomes and minimize complications.
摘要：
显微外科手术的自由组织转移已成功实施，用于儿童的各种重建应用。这项研究的目的是确定接受自由组织转移的儿科患者围手术期管理的最佳可用证据，并将其用于制定循证护理指南。
在PubMed中进行了系统评价，Embase,Scopus,和Cochrane图书馆数据库。因为对儿科显微外科文献的初步搜索获得的数据很少，证据水平很低，还包括接受大手术的健康儿童的小儿麻醉指南.排除标准包括对围手术期护理的模糊描述，病例报告,以及对综合征或慢性病儿童的研究。
确认了两百四篇文章，53人符合纳入标准。针对儿科人群的管理方法被用来制定建议。找到了高质量的麻醉数据，镇痛,液体管理/输血，抗凝（I级证据）。对于患者体温（III级证据）和血管扩张剂使用（IV级证据），发现质量较低的证据。主要建议包括使用七氟醚进行全身麻醉，实施多模式镇痛策略，限制术前禁食，限制输血，直到血红蛋白水平低于7g/dl，除非患者有症状，并为高危患者保留化学静脉血栓栓塞预防。
儿科特定指南很重要，因为他们承认儿童的生理差异，从成人研究推断时可能会被忽视。这些基于证据的建议是迈向接受整形外科手术的儿科患者围手术期护理标准化的关键的第一步。包括免费的组织转移,以改善结果和减少并发症。
在PubMed中进行了系统评价，Embase,Scopus,和Cochrane图书馆数据库。因为对儿科显微外科文献的初步搜索获得的数据很少，证据水平很低，还包括接受大手术的健康儿童的小儿麻醉指南.排除标准包括对围手术期护理的模糊描述，病例报告,以及对综合征或慢性病儿童的研究。
确认了两百四篇文章，53人符合纳入标准。针对儿科人群的管理方法被用来制定建议。找到了高质量的麻醉数据，镇痛,液体管理/输血，抗凝（I级证据）。对于患者体温（III级证据）和血管扩张剂使用（IV级证据），发现质量较低的证据。主要建议包括使用七氟醚进行全身麻醉，实施多模式镇痛策略，限制术前禁食，限制输血，直到血红蛋白水平低于7g/dl，除非患者有症状，并为高危患者保留化学静脉血栓栓塞预防。
儿科特定指南很重要，因为他们承认儿童的生理差异，从成人研究推断时可能会被忽视。这些基于证据的建议是迈向接受整形外科手术的儿科患者围手术期护理标准化的关键的第一步。包括免费的组织转移,以改善结果和减少并发症。
