The inflammatory response in three different flap procedures was investigated by measuring the preoperative and postoperative levels of C-reactive protein, leukocyte count, and body temperature. Patients scheduled for delayed breast reconstruction were operated on with the lateral thoracodorsal flap, the latissimus dorsi flap, or the pedicled TRAM flap. All patients received 2 gm of intravenous cloxacillin for antibiotic prophylaxis and 1 gm of paracetamol four times a day as basic treatment for postoperative pain. Within each treatment group, significant postoperative changes in C-reactive protein levels, leukocyte count, and body temperature were noted when compared with preoperative values. The highest C-reactive protein level (130 mg/ml) was found in the TRAM group on the third postoperative day. The kinetic pattern of C-reactive protein was similar for the latissimus dorsi flap and lateral thoracodorsal flap procedures, but the maximum C-reactive protein levels were significantly lower, 74 and 44 mg/ml respectively. Small (0.5 to 0.9°C) but significant differences in body temperature were also noted on the second and third postoperative day. The TRAM flap group had the highest, the latissimus dorsi flap group intermediate, and the lateral thoracodorsal flap group the lowest value. The postoperative C-reactive protein levels seem to reflect the extent of the surgical trauma. (Plast. Reconstr. Surg. 101: 1524, 1998.)
Stockholm and Uppsala, Sweden
Lennart Blomqvist, M.D., Ph.D. Department of Plastic Surgery Karolinska Hospital/Stockholm Söder Hospital 118 83 Stockholm, Sweden
From the Departments of Plastic Surgery and Clinical Chemistry at Stockholm Söder Hospital, the Department of Rheumatology at Karolinska Hospital, and the Department of Pathology at Akademiska Hospital. Received for publication October 15, 1996; revised May 27, 1997.
Presented at the 26th Nordic Congress of Plastic Surgery on June 14, 1996, in Stockholm, Sweden.