Lower Extremity Flap Salvage in Thrombophilic Patients: Managing Expectations in the Setting of Microvascular Thrombosis
Lower Extremity Flap Salvage in Thrombophilic Patients: Managing Expectations in the Setting of Microvascular Thrombosis
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易栓症患者的下肢皮瓣抢救：管理微血管血栓形成的期望
DOI：
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发表时间：
2016
影响因子：
2.1
通讯作者：
K. Evans
中科院分区：
文献类型：
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作者：
Michael V. DeFazio;Rex W. Hung;Kevin D. Han;Haley A. Bunting;K. Evans
背景未确诊的血栓性疾病是皮瓣失败的危险因素；然而，其在显微外科重建患者中的患病率尚不清楚。我们介绍了我们的经验，游离组织移植（FTT）在高风险人群的下肢患者记录在案的血栓，通过术前筛查确定。方法2012年1月至2014年4月，在同一外科医生的指导下，对41例患者进行了43个游离皮瓣的非创伤性下肢重建。术前使用病史信息和标准化实验室检测筛查患者是否有血栓形成。比较了血栓形成组和非血栓形成组的人口统计学数据、围手术期管理、结果和挽救率。结果术前常规筛查25例患者（61%）发现52个血栓性特征。最常见的性状是纤溶酶原激活物抑制剂-1 4G/5G变异（n = 12）和亚甲基四氢叶酸还原酶A1298C （n = 10）和C677T （n = 9）多态性。虽然血栓形成患者和非血栓形成患者的成功率相似（84比94%，p = 0.15），但血栓形成并发症（25比14%，p = 0.09）和术后血栓形成后皮瓣失效（100比33%，p = 0.05）似乎在血栓形成患者中更为常见。平均而言，微血管并发症在血栓形成的情况下表现较晚（平均4.8天对18小时，p = 0.20），并与较差的总体预后相关（挽救率，0对67%，p = 0.05）。结论：尽管成功率很高，但血栓形成似乎增加了下肢FTT后不可挽救的风险。这些信息应该用于帮助患者了解显微外科重建的风险和益处，因为在存在血栓性疾病的情况下，术后血栓事件后的挽救率接近0%。
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 thrombosis (100 vs. 33%; p = 0.05) appeared to be more common in patients with thrombophilia. On average, microvascular complications manifested later in the setting of thrombophilia (mean 4.8 days vs. 18 hours; p = 0.20) and were associated with a worse overall prognosis (salvage rate, 0 vs. 67%; p = 0.05). Conclusions Despite high success rates, thrombophilia appears to increase the risk of nonsalvageability following lower extremity FTT. This information should be used to help counsel patients regarding the risks and benefits of microsurgical reconstruction, as salvage rates following postoperative thrombotic events approach 0% in the presence of thrombophilia.
DOI：
10.1182/asheducation-2007.1.127
发表时间：
2007
期刊：
Hematology. American Society of Hematology. Education Program
影响因子：
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作者：
J. Heit
通讯作者：
J. Heit