{
  "abstract": "Application for ESRA Abstract Prizes:Background and Aims The free fibula flap is a versatile option for reconstructing bone defects. These are long surgeries with microvascular approaches. Anesthesia management is important for hemodynamic maintenance of the graft and pain control. This case highlights perioperative strategies supported by current evidence.Methods A 36-year-old male with humeral pseudoarthrosis after multiple surgeries for a blast-related fracture underwent a 7 cm free fibula flap transfer from the right leg. Simultaneous donor and recipient site surgeries were performed under general anesthesia and dual ultrasound-guided blocks: a popliteal-sciatic block (20 mL levobupivacaine 0.25%) for the donor site, and a supraclavicular continuous block, posterolateral approach in plane, between the upper and middle trunk (20 mL levobupivacaine 0.25% + lidocaine 1% reinforcements) for the recipient site. The 10-hour procedure involved 1L blood loss, managed with tranexamic acid, fibrinogen, and transfusion. Hemodynamic and gasometric monitoring ensured stability without vasopressors. A Doppler probe was used for flap monitoring. Postoperative analgesia consisted of continuous infusion of 0.125% levobupivacaine at 4 mL/h via supraclavicular catheter and Patient Controlled Analgesia, achieving NRS < 3 and avoiding opioid rescue. Doppler signals remained stable, and the patient was discharged without complications.Results Free flap failure ranges from 1–5%, especially in trauma and early postoperative periods. General anesthesia is preferred for complex surgeries, and regional blocks improve perfusion via sympathetic blockade, minimizing thrombosis risk. Perioperative pain management with continuous blocks reduces stress and vasospasms, protecting the flap.Abstract P316 Figure 1Removal of osteosynthesis material, bone resection of pseudoarthrosis margins, circular external fixation, steinmann intramedullary nailing and cement spacerAbstract P316 Figure 2Ultrasound image of supraclavicular catheter, posterolateral plane approach, between the upper and middle trunkAbstract P316 Figure 3Free fibula flap placement on bone defectConclusions Free flap reconstruction demands multidisciplinary planning. Regional anesthesia protects the flap and reduces opioid consumption, though further evidence is needed in microsurgery.",
  "authors": [
    {
      "affiliations": [
        "Anestesiologia i Reanimació, Hospital Universitari Mútua Terrassa, Barcelona, Spain"
      ],
      "name": "M Mercè Miranda Barragan"
    },
    {
      "affiliations": [
        "Anestesiologia i Reanimació, Hospital Universitari Mútua Terrassa, Terrassa, Spain"
      ],
      "name": "Héctor Villanueva Sánchez"
    },
    {
      "affiliations": [
        "Anestesiologia i Reanimació, Hospital Universitari Mútua Terrassa, Terrassa, Spain"
      ],
      "name": "Marga Novellas Canosa"
    },
    {
      "affiliations": [
        "Anestesiologia i Reanimació, Hospital Universitari Mútua Terrassa, Barcelona, Spain"
      ],
      "name": "Miriam De la Maza Segovia"
    },
    {
      "affiliations": [
        "Anestesiologia i Reanimació, Hospital Universitari Mútua Terrassa, Terrassa, Spain"
      ],
      "name": "Esther García Tapias"
    },
    {
      "affiliations": [
        "Anestesiologia i Reanimació, Hospital Universitari Mútua Terrassa, Terrassa, Spain"
      ],
      "name": "Marc Bausili Ribera"
    }
  ],
  "title": "P316 Perioperative anesthetic management of free fibula flap to humeral diaphysis due to war injury: a case report",
  "uid": "3a515d14-016d-5482-ac58-5acdaa6401bd"
}