Microsurgical breast reconstruction and primary hypercoagulable disorders

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2024-02-01 DOI:10.1002/micr.31146

Rakel M. Zarb MD, Charles Lamberton BS, Aishwarya Ramamurthi MD, Vince Berry BS, Karri A. Adamson MD, Erin L. Doren MD, MPH, Patrick C. Hettinger MD, John B. Hijjawi MD, John A. LoGiudice MD

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引用次数: 0

Abstract

Background

Primary hypercoagulable disorders pose a significant challenge to microsurgeons and have traditionally been regarded as a relative contraindication to free tissue transfer. Since free flaps offer numerous advantages in breast reconstruction, there is an effort to expand the population to whom these operations can be safely offered. The purpose of this study is to describe our chemoprophylaxis regimen in cases of primary hypercoagulability, as well as to compare flap outcomes and complications between women with and without hypercoagulability.

Patients and Methods

A single institution retrospective review identified 15 patients (25 flaps) with known primary hypercoagulability who underwent microsurgical breast reconstruction from 2010 through 2020. There were 785 patients (1268 flaps) without primary hypercoagulability who underwent microsurgical breast reconstruction, including 40 patients (73 flaps) with a history of venous thromboembolism (VTE), evaluated for comparison. Patient characteristics, thromboprophylaxis regimen, and surgical outcomes were collected. In carrying out this cohort study, we have adhered to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Results

Fifteen patients with primary hypercoagulability were identified, including heterozygous factor V Leiden mutation (n = 12), protein S deficiency (n = 1), prothrombin mutation (n = 1), and primary antiphospholipid syndrome (n = 1). Thirteen of these (87%) were discharged with an extended LMWH course. There was no postoperative VTE or mortality in this cohort, and no significant difference in hematoma or transfusion compared with the control group (p = .31, p = .87, respectively). The flap loss rate was 4% in the hypercoagulable group compared with 0.92% in the control group (p = .15). The salvage for arterial or venous compromise in the hypercoagulable group was poor (0% vs. 52%, p = .3).

Conclusion

Microsurgical breast reconstruction in women with primary hypercoagulability disorders is feasible with acceptable risk of flap loss but poor salvage potential. Postoperative thromboprophylaxis with extended prophylactic LMWH in this population appears to be a safe regimen.

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显微外科乳房再造与原发性高凝血症

背景原发性高凝血症给显微外科医生带来了巨大的挑战，传统上被认为是游离组织转移的相对禁忌症。由于游离组织瓣在乳房重建中具有诸多优势，因此人们正在努力扩大可安全进行此类手术的人群。本研究的目的是描述我们对原发性高凝状态病例的化学预防方案，并比较有和没有高凝状态的女性的皮瓣效果和并发症。患者和方法通过单个机构的回顾性审查，确定了 15 名已知患有原发性高凝状态的患者（25 个皮瓣），这些患者在 2010 年至 2020 年期间接受了显微外科乳房再造手术。接受显微外科乳房再造手术的 785 名患者（1268 个皮瓣）不存在原发性高凝状态，其中包括 40 名有静脉血栓栓塞症（VTE）病史的患者（73 个皮瓣）。研究收集了患者特征、血栓预防方案和手术结果。在进行这项队列研究时，我们遵守了加强流行病学观察性研究报告（STROBE）指南。结果共发现 15 例原发性高凝状态患者，包括杂合子因子 V Leiden 突变（12 例）、蛋白 S 缺乏（1 例）、凝血酶原突变（1 例）和原发性抗磷脂综合征（1 例）。其中 13 人（87%）出院时延长了 LMWH 疗程。该组患者术后无 VTE 或死亡，血肿或输血与对照组相比无显著差异（分别为 p = .31 和 p = .87）。高凝组的皮瓣脱落率为 4%，而对照组为 0.92%（p = .15）。高凝血症组的动脉或静脉损伤抢救效果不佳（0% 对 52%，P = .3）。结论对患有原发性高凝状态疾病的女性进行显微外科乳房重建是可行的，但皮瓣脱落的风险可以接受，但挽救的可能性较低。在这类人群中，术后延长预防性 LMWH 的血栓预防似乎是一种安全的方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.