Lower Extremity Flap Salvage in Thrombophilic Patients: Managing Expectations in the Setting of Microvascular Thrombosis

Journal of Reconstructive Microsurgery
Michael V DeFazioKaren K Evans

Abstract

Background Undiagnosed thrombophilia is a risk factor for flap failure; however, its prevalence in patients undergoing microsurgical reconstruction is unknown. We present our experience with free tissue transfer (FTT) in a high-risk population of lower extremity patients with documented thrombophilia, identified through preoperative screening. Methods Between January 2012 and April 2014, 41 patients underwent 43 free flaps for nontraumatic, lower extremity reconstruction by a single surgeon. Patients were preoperatively screened for thrombophilia using historical information and standardized laboratory testing. Demographic data, perioperative management, outcomes, and salvage rates for thrombophilic and nonthrombophilic cohorts were compared. Results Routine preoperative screening identified 52 thrombophilic traits among 25 patients in this series (61%). The most common traits were the plasminogen activator inhibitor-1 4G/5G variant (n = 12) and the methylenetetrahydrofolate reductase A1298C (n = 10) and C677T (n = 9) polymorphisms. While success rates were similar between thrombophilic and nonthrombophilic patients (84 vs. 94%; p = 0.15), thrombotic complications (25 vs. 14%; p = 0.09) and flap failure following postoperative ...Continue Reading

Citations

Sep 28, 2018·Journal of Surgical Oncology·Joon Pio Jp HongHyun Suk Peter Suh
Dec 12, 2018·Plastic and Reconstructive Surgery·David E JanhoferKaren Kim Evans
Nov 28, 2019·Archives of Plastic Surgery·Johannes Albert Biben, Parintosa Atmodiwirjo
Dec 29, 2019·Plastic and Reconstructive Surgery·David E JanhoferKaren Kim Evans
Mar 7, 2021·Clinics in Plastic Surgery·Joon Pio HongHyunsuk Peter Suh

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