Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
J Reconstr Microsurg. 2012 Oct;28(8):515-20. doi: 10.1055/s-0032-1315771. Epub 2012 Jun 28.
Despite appropriate surgical technique and follow-up, flap failures can be encountered for which no valid reason is evident. Current literature states that these unpredictable flap failures can be caused by unknown patient factors, such as undiagnosed hypercoagulability. Our approach and experience utilizing an algorithm to minimize unpredictable failures in microvascular breast reconstruction by predetermining hypercoagulation risk factors in preoperative patients is presented. A prospective assessment of microsurgical breast reconstruction candidates between October 2007 and December 2010 was conducted. Patients were questioned about their tendency toward hypercoagulation. A thrombophilia panel was requested for patients confirming any risk factors. Appropriate surgical planning was conducted according to results of the panel. Of the 60 patients thoroughly questioned about hypercoagulation tendency, 21 (35%) confirmed having prothrombotic tendency and were referred to the thrombophilia testing. The results indicated hypercoagulation in 9 (15%) patients. The primary reconstruction plan of utilizing free flaps was abandoned for these patients and pedicled flaps or implants were preferred for reconstruction. These percentages emphasize the value of questioning risk factors and testing for hypercoagulation in patients seeking microsurgical breast reconstruction. We believe that detailed preoperative questioning of risk factors and appropriate testing according to prothrombotic tendency is beneficial in minimizing unpredictable flap failures and increasing rates of success.
尽管采用了适当的手术技术和随访，但仍可能会遇到无法明确原因的皮瓣失败。目前的文献表明，这些不可预测的皮瓣失败可能是由未知的患者因素引起的，例如未确诊的高凝状态。我们提出了一种通过在术前患者中预先确定高凝风险因素来最小化微血管乳房重建中不可预测失败的算法方法和经验。在 2007 年 10 月至 2010 年 12 月期间，对接受显微外科乳房重建的候选患者进行了前瞻性评估。询问了患者是否有倾向于高凝状态的倾向。对于确认有任何危险因素的患者，要求进行血栓形成倾向小组检查。根据小组的结果进行了适当的手术计划。在对高凝倾向进行了彻底询问的 60 名患者中，有 21 名（35％）患者确认存在血栓前倾向，并接受了血栓形成倾向测试。结果表明 9 名（15％）患者存在高凝状态。这些患者放弃了使用游离皮瓣的主要重建计划，而选择了带蒂皮瓣或植入物进行重建。这些百分比强调了在寻求显微外科乳房重建的患者中询问危险因素和检测高凝状态的价值。我们认为，详细询问风险因素并根据血栓前倾向进行适当的检测，有助于最小化不可预测的皮瓣失败并提高成功率。
