Perioperative Hypothermia in Medium- and Large-Volume Plastic Surgery: Clinical and Surgical Implications and Practical Prevention Strategies

Inadvertent perioperative hypothermia (IPH), defined as a core temperature below 36 °C, is a common complication of elective procedures under general anesthesia and has traditionally been treated as an anesthetic concern. In medium- and large-volume plastic surgery, including abdominoplasty, large-volume liposuction, combined and postbariatric body contouring, and autologous and microsurgical reconstruction, wide body-surface exposure, cold tumescent solution, prolonged operative time, and combined anesthesia amplify this risk and make it directly relevant to surgical outcomes. This narrative review, structured around the Scale for the Assessment of Narrative Review Articles (SANRA) domains, synthesizes the pathophysiology; the wound-healing, flap, and microsurgical implications most relevant to plastic surgery; the subclinical hemodynamic consequences; the surgical outcomes; and practical prevention strategies for IPH, drawing on searches in PubMed/MEDLINE, Cochrane Library, SciELO, and Embase (1996-2024). Even mild IPH meaningfully increases the risks of surgical site infection, intraoperative bleeding, ischemic cardiac events, and delayed emergence; of particular concern in plastic surgery, it fosters a vasoconstricted, hypoperfused microcirculatory environment that threatens wound edges, random-pattern and pedicled flaps, and microsurgical anastomoses. Postoperative hypothermia is especially frequent after prolonged operations. Prewarming, forced-air warming, and fluid warming substantially reduce IPH incidence. We propose that perioperative normothermia be treated as an auditable institutional quality indicator, shared across the perioperative team, with the plastic surgeon contributing specific, protocol-driven actions.