ABSTRACT
Postoperative management procedures after microsurgery are well-established. Usually,
maintaining an adequate plasma volume will lower blood viscosity and will provide
an adequate arterial inflow to keep the replantation or the flap viable in routine
microsurgical procedures. But if the patient's underlying condition is neglected,
disasterous complications may occur. The authors report two cases with severe postoperative
complications after microsurgery. One patient was a 38-year-old male who suffered
from diabetic foot ulcer and received a free muscle flap transfer. He developed acute
pulmonary edema at day 6 postoperatively. The other patient was a 20-year-old pregnant
woman at 31 weeks gestation who developed pulmonary edema on the POD 4 following microsurgical
replantation of the thumb and index finger of her left hand. The complications were
believed to be caused by fluid overload and neglect of the patients' underlying conditions.
Knowledge of possible precipitating factors and careful monitoring of fluid should
avoid acute pulmonary edema after microsurgery under certain unusual conditions.
