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Lower Extremity Free Tissue Transfer in the Setting of Thrombophilia: Analysis of Perioperative Anticoagulation Protocols and Predictors of Flap Failure
- Source :
- Journal of Reconstructive Microsurgery. 35:270-286
- Publication Year :
- 2018
- Publisher :
- Georg Thieme Verlag KG, 2018.
-
Abstract
- Background No consensus exists regarding the optimal strategy for perioperative thromboprophylaxis in high-risk microsurgical populations. We present our experience with lower extremity free tissue transfer (FTT) in thrombophilic patients and compare outcomes between non-stratified and risk-stratified anticoagulation protocols. Methods Between January 2013 and December 2017, 57 patients with documented thrombophilia underwent FTT for non-traumatic, lower extremity reconstruction by a single surgeon. Patients were divided into two cohorts based on the introduction of a novel, risk-stratified algorithm for perioperative anticoagulation in July 2015. Demographic data, chemoprophylaxis profiles, flap outcomes, and complications were retrospectively compared across time periods. Results Fifty-seven free flaps were performed in hypercoagulable patients treated with non-stratified (n = 27) or risk-stratified (n = 30) thromboprophylaxis. Patients in the risk-stratified cohort received intravenous heparin more often than non-stratified controls (73 vs. 15%, p Conclusion Selective therapeutic anticoagulation may improve microsurgical outcomes in high-risk patients with thrombophilia. Our findings highlight the importance of meticulous technique and recipient-vessel selection as critical determinants of flap success in this population.
- Subjects :
- Adult
Male
medicine.medical_specialty
Population
030230 surgery
Thrombophilia
Free Tissue Flaps
Perioperative Care
Young Adult
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Clinical Protocols
Humans
Medicine
education
Aged
Retrospective Studies
education.field_of_study
business.industry
Graft Survival
Anticoagulants
Flap failure
Venous Thromboembolism
Perioperative
Middle Aged
medicine.disease
Single surgeon
Tissue transfer
Surgery
Treatment Outcome
Lower Extremity
030220 oncology & carcinogenesis
Cohort
Chemoprophylaxis
Female
business
Subjects
Details
- ISSN :
- 10988947 and 0743684X
- Volume :
- 35
- Database :
- OpenAIRE
- Journal :
- Journal of Reconstructive Microsurgery
- Accession number :
- edsair.doi.dedup.....9099981844e9fa1bc5fdeb61b411e4cc