Factors affecting perioperative hemostatic abnormalities in prolonged maxillofacial surgery

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It is believed that the hemostatic abnormalities occur during prolonged surgery. Perioperative hypercoagulability is recognized as a result of the basic disease, the releasing tissue factor (TF) into the circulation due to the soft tissue invasion, the invasion of endothelial cell and so on. However, it has been unknown what factors eause the hemostatic abnormalities during prolonged surgery. In this study, we evaluated the perioperative changes of molecular markers for the purpose of the investigation of investigation of factors causing hemostatic abnormalities during prolonged surgeryThe subjects was undergone prolonged malignant surgery, more than eight hours of duration, accompanied with a tumor dissection, a radical neek dissection and a reconstruetion by a free flap implantation. Molecular markers of prothrombin fragment 1+2 (F1+2), interleukin 6 (IL-6), TF, tissue factor pathway inhibitor (TFPI), thrombomodulin (YM), α2-plasmin inhibitor-plasmin complex (PAP), tissue-type plasmi … More nogen activator (tPA) were measured at the time of anesthesia start, the end of radial neek dissection, the end of tissue transplantation, the end of anesthesia, and the first and seeond postoperative daysWe obtained the following results :1. The values of F1+2 significantly increased during operation and declined postoperatively2. The values of IL-6 and tPA also increased intraoperatively and reached the maximum at the end of anesthesia3. The values of TF, TFPI, TM and PAP did not significant changed during and postoperatively.These results reveal that the releasing cytokines into the circulation due to the surgical invasion influenced the hypercoagulability during the surgery, and is one of the factors causing hemostatic abnormalities. Furthermore, the surgical invation must enfluence to the endthelium to release tPA.However, since TF that has been recognized as a main factor to the hypercoagulation during surgery, and TM that is released by the significant degree of vascular injury did not significantly changed, the soft tissue invasion must not important to form the hypercoagulability during prolonged surgery in maxillofacial region. Less