Davison Steven P, Kessler Craig M, Al-Attar Ali
Washington, D.C. From the Department of Plastic Surgery and the Division of Coagulation, Georgetown University Hospital.
Plast Reconstr Surg. 2009 Aug;124(2):490-495. doi: 10.1097/PRS.0b013e3181adcf35.
Microvascular free flap techniques have improved over the past two decades such that flap failure rates have dropped to under 3 percent in most large series of high-volume centers. However, despite technical and patient-selection advances, some components of free flap failure might be attributable to undiagnosed patient factors.
In this clinicopathologic conference article, the authors present four patients with major free flap microvascular complications who were later diagnosed with multiple risk factors for hypercoagulability and biochemical abnormalities, and present the characteristic associated findings.
Previously undiagnosed hypercoagulability was present in four patients with major free flap microvascular complications. Hematologic consultation and laboratory investigation revealed the biochemical abnormalities.
In certain patients undergoing microvascular free flap reconstruction, undiagnosed hypercoagulability risk factors can be a source of free flap failure that is independent of patient selection or technical factors. Diagnosis, management, patient counseling, and initiation of deep venous thromboembolism prophylaxis measures are critical clinical components of care of these patients.
在过去二十年中，游离微血管皮瓣技术有所改进，在大多数大型高容量中心，皮瓣失败率已降至3%以下。然而，尽管在技术和患者选择方面取得了进展，但游离皮瓣失败的一些因素可能归因于未被诊断出的患者因素。
在这篇临床病理会议文章中，作者介绍了四名发生主要游离皮瓣微血管并发症的患者，这些患者后来被诊断出具有多种高凝风险因素和生化异常，并介绍了相关的特征性发现。
四名发生主要游离皮瓣微血管并发症的患者存在先前未被诊断出的高凝状态。血液学会诊和实验室检查揭示了生化异常。
在某些接受游离微血管皮瓣重建的患者中，未被诊断出的高凝风险因素可能是游离皮瓣失败的一个原因，这与患者选择或技术因素无关。诊断、管理、患者咨询以及启动深静脉血栓栓塞预防措施是这些患者护理的关键临床组成部分。
