Philadelphia, Pa. From the Division of Plastic Surgery; the Department of Medicine, Division of Hematology; and Department of Pathology and Laboratory Medicine, University of Pennsylvania Health System.
Plast Reconstr Surg. 2012 Feb;129(2):443-453. doi: 10.1097/PRS.0b013e31823aec4d.
Hypercoagulability or thrombophilia is a group of inherited or acquired conditions associated with a predisposition to thrombosis. Most hypercoagulable states alter the blood itself or affect the vasculature, directly creating a detrimental environment for microsurgery. The authors present their series of hypercoagulable patients who underwent free flap reconstruction.
A retrospective review was conducted of all free flaps performed between January 1, 2005, and October 1, 2010, at the University of Pennsylvania. A total of 2032 flaps were performed. Forty-one patients or 58 free flaps (2.9 percent) were identified as having a diagnosed thrombophilia or previous thromboembolic event.
Of the 41 patients, 36 were women and five were men. Diagnosis included factor V Leiden mutation, protein C deficiency, hyperhomocysteinemia, antiphospholipid antibody syndrome, prothrombin gene mutation, factor VIII elevation, anticardiolipin antibody syndrome, and essential thrombocytosis. The group of patients with prior thrombotic events (many with concomitant events and diagnoses) included deep vein thrombosis, pulmonary embolus, myocardial infarction before the age of 50, and embolic stroke. Twelve patients (29.3 percent) were actively followed by a hematologist. The rate of thrombosis was 20.7 percent (12 flaps), including those occurring intraoperatively. The salvage rate for a postoperative thrombosed flap in this group was 0 percent. The flap loss rate was 15.5 percent.
Although hypercoagulability produces an unfavorable condition for microvascular reconstruction, free tissue transfer is feasible. In this series, the authors had an 80 percent success rate. Collaboration with a hematologist may be helpful. In this group, flap thrombosis seems to occur in the delayed period. Even with operative reexploration, salvage rates have not been promising.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.
高凝状态或血栓形成倾向是一组与血栓形成易感性相关的遗传性或获得性疾病。大多数高凝状态会改变血液本身或影响血管系统，直接为显微手术创造不利环境。作者介绍了他们一系列患有高凝状态的患者，这些患者接受了游离皮瓣重建。
对 2005 年 1 月 1 日至 2010 年 10 月 1 日期间在宾夕法尼亚大学进行的所有游离皮瓣进行回顾性分析。共进行了 2032 个皮瓣。有 41 名患者或 58 个游离皮瓣（2.9%）被诊断为患有血栓形成倾向或既往血栓栓塞事件。
41 名患者中，36 名女性，5 名男性。诊断包括因子 V Leiden 突变、蛋白 C 缺乏、高同型半胱氨酸血症、抗磷脂抗体综合征、凝血酶原基因突变、因子 VIII 升高、抗心磷脂抗体综合征和特发性血小板增多症。有既往血栓形成事件（许多患者同时伴有其他事件和诊断）的患者组包括深静脉血栓形成、肺栓塞、50 岁前心肌梗死和栓塞性中风。12 名患者（29.3%）正在接受血液科医生的积极随访。血栓形成率为 20.7%（12 个皮瓣），包括术中发生的血栓形成。该组术后血栓形成皮瓣的抢救成功率为 0%。皮瓣失效率为 15.5%。
尽管高凝状态对微血管重建产生不利条件，但游离组织转移是可行的。在本系列中，作者的成功率为 80%。与血液科医生合作可能会有所帮助。在该组中，皮瓣血栓似乎发生在延迟期。即使进行手术再次探查，抢救成功率也不高。
临床问题/证据水平：风险，IV。
