Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Microsurgery. 2011 Jul;31(5):409-12. doi: 10.1002/micr.20879. Epub 2011 Apr 18.
Two cases are reported of flap loss following microsurgical perforator flap breast reconstruction in patients diagnosed with a factor V Leiden mutation. Factor V Leiden is the most common inherited cause of hypercoagulability, leading to an increased risk of thrombotic events. The first patient underwent a deep inferior epigastric artery perforator flap and then had recurrent arterial thrombosis both intraoperatively and postoperatively. This patient was subsequently diagnosed with a factor V Leiden mutation. The second patient had a known factor V Leiden mutation and underwent a superior gluteal artery perforator flap, which developed thrombosis and flap loss 2 days later. Preoperative assessment of a personal or family history of unexplained venous or arterial thrombosis should prompt suspicion of a factor V Leiden mutation. This mutation places patients at high risk for thromboembolic events in microvascular breast reconstruction, particularly when oral contraceptives or tamoxifen are used in conjunction.
报告了两例接受微血管乳房重建术的患者出现皮瓣丢失的病例，这些患者被诊断为因子 V 莱顿突变。因子 V 莱顿突变是最常见的遗传性高凝状态原因，导致血栓事件的风险增加。第一例患者接受了腹壁下动脉穿支皮瓣游离移植术，随后在手术中和手术后均发生了动脉血栓形成。该患者随后被诊断为因子 V 莱顿突变。第二例患者已知存在因子 V 莱顿突变，并接受了臀上动脉穿支皮瓣游离移植术，术后 2 天发生血栓形成和皮瓣丢失。对于个人或家族中存在不明原因的静脉或动脉血栓形成的病史，应怀疑存在因子 V 莱顿突变。这种突变使患者在接受微血管乳房重建术时处于血栓栓塞事件的高风险中，特别是在同时使用口服避孕药或他莫昔芬时。
