Philadelphia, Pa. From the Division of Plastic Surgery and Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania.
Plast Reconstr Surg. 2012 Jan;129(1):8e-15e. doi: 10.1097/PRS.0b013e3182361f7f.
Microvascular free-tissue transfer is a reliable pillar of reconstructive surgery, yet pedicle thrombosis remains a challenge. The authors examined the phenomenon of late venous thrombosis (after postoperative day 3) and detail a method of flap salvage that can be utilized following this microvascular insult.
A retrospective review was performed of all free flap breast reconstructions performed by the senior author (J.M.S.) from 1991 to 2008, utilizing a prospectively maintained database. All cases of postoperative thromboses were evaluated. Late venous thrombosis was defined as a thrombosis occurring after postoperative day 3.
A total of 1277 free flap breast reconstructions were performed over the 17-year period. Nineteen flaps had venous thromboses (1.5 percent), and 10 of these occurred after postoperative day 3 (average, 5.67 days; range, 4 to 12 days). Operative exploration was employed in seven of 10 cases, with the remaining patients presenting too late or too advanced for operative intervention. Sixty percent of flaps were fully salvaged, and two were partially saved, with some subsequent volume loss. Earlier late venous thrombosis presentation led to better outcomes overall.
Late venous thrombosis is a rare phenomenon that, although occurring late in the postoperative course, is an acute event. Early recognition and urgent treatment are key to flap salvage, with clinical judgment dictating the treatment choice. In the absence of extenuating circumstances, the authors prefer urgent exploration in the operating room, as flap survival following late venous thrombosis is a race against time but with a high probability of salvage if the proper steps are taken.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
游离组织皮瓣移植是重建手术的可靠支柱，但蒂血管血栓仍然是一个挑战。作者研究了术后第 3 天（术后第 3 天）后静脉血栓形成的现象，并详细介绍了一种可以在这种微血管损伤后用于挽救皮瓣的方法。
对 1991 年至 2008 年由资深作者（J.M.S.）进行的所有游离皮瓣乳房重建进行了回顾性回顾，使用了一个前瞻性维护的数据库。评估了所有术后血栓形成的病例。晚期静脉血栓形成定义为术后第 3 天发生的血栓形成。
在 17 年期间，共进行了 1277 例游离皮瓣乳房重建。19 个皮瓣发生静脉血栓形成（1.5%），其中 10 个发生在术后第 3 天（平均 5.67 天；范围 4 至 12 天）。10 例中有 7 例进行了手术探查，其余患者因手术干预太晚或太先进而无法进行手术干预。60%的皮瓣完全挽救，2 个部分挽救，随后体积略有减少。较早的晚期静脉血栓形成表现总体上导致更好的结果。
晚期静脉血栓形成是一种罕见的现象，尽管发生在术后过程的晚期，但却是一种急性事件。早期识别和紧急治疗是挽救皮瓣的关键，临床判断决定了治疗选择。在没有特殊情况的情况下，作者更喜欢在手术室进行紧急探查，因为晚期静脉血栓形成后皮瓣的存活是一场与时间的赛跑，但如果采取正确的步骤，挽救的可能性很高。
临床问题/证据水平：治疗，IV。
