Iowa City, Iowa; Dallas, Texas; and Pittsburgh, Pa. From the Department of Surgery, Division of Plastic Surgery, University of Iowa Hospitals and Clinics; the Department of Plastic Surgery, University of Texas Southwestern Medical Center; and the Departments of Medicine and Plastic Surgery, University of Pittsburgh School of Medicine.
Plast Reconstr Surg. 2013 Aug;132(2):279-284. doi: 10.1097/PRS.0b013e318295870e.
Venous thromboembolism continues to be problematic despite increased recognition and advancements in venous thromboembolism prophylaxis. Although migration toward preoperative chemoprophylaxis increases, plastic surgeons seem reticent to adopt this practice. This study evaluates preoperative enoxaparin administration in breast reconstruction patients.
Patients undergoing breast reconstruction performed by a single surgeon over a 5-year period were evaluated retrospectively. The authors introduced preoperative chemoprophylaxis with enoxaparin in all breast reconstructions during this time. Prosthetic-based and microsurgical breast reconstructions were examined. Patients were divided into two groups: those who did and those who did not receive preoperative enoxaparin. The authors reviewed patient demographics, comorbidities, and complications, focusing on bleeding complications.
Three hundred patients (450 breasts) were included. One hundred fifty-four patients (244 breasts) underwent reconstruction with tissue expanders, and 146 (206 breasts) underwent free flap reconstructions. One hundred seventy-nine of 300 were given preoperative enoxaparin. Eleven hematomas occurred, eight (4.5 percent) in the enoxaparin group and three (2.5 percent) without enoxaparin (p = 0.399). Blood transfusions were given to four patients (2.2 percent) who received enoxaparin and one patient (0.8 percent) who did not (p = 0.652). Finally, any type of bleeding complication occurred in 11 patients (6.1 percent) with enoxaparin and in four (3.3 percent) without (p = 0.419). Larger breasts were more likely to receive enoxaparin (p = 0.011), which did not result in higher bleeding complications.
In this retrospective study, the authors found that preoperative chemoprophylaxis in breast reconstruction was associated with an acceptable rate of postoperative bleeding complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
尽管人们对静脉血栓栓塞症的认识不断提高，并且在预防静脉血栓栓塞症方面也取得了进展，但静脉血栓栓塞症仍持续存在问题。尽管向术前化学预防的转变有所增加，但整形外科医生似乎不愿意采用这种做法。本研究评估了接受乳房重建手术的患者的术前依诺肝素给药情况。
回顾性评估了在 5 年内由一位外科医生进行的乳房重建手术的患者。在此期间，作者在所有乳房重建手术中引入了术前依诺肝素化学预防。检查了假体和显微乳房重建。患者分为两组：接受术前依诺肝素的患者和未接受术前依诺肝素的患者。作者回顾了患者的人口统计学资料、合并症和并发症，重点关注出血并发症。
共纳入 300 例患者（450 侧乳房）。154 例患者（244 侧乳房）接受了组织扩张器重建，146 例患者（206 侧乳房）接受了游离皮瓣重建。300 例患者中有 179 例接受了术前依诺肝素治疗。发生血肿 11 例，依诺肝素组 8 例（4.5%），无依诺肝素组 3 例（2.5%）（p=0.399）。接受依诺肝素的 4 例患者（2.2%）和未接受依诺肝素的 1 例患者（0.8%）给予了输血（p=0.652）。最后，接受依诺肝素治疗的 11 例患者（6.1%）和未接受依诺肝素治疗的 4 例患者（3.3%）发生了任何类型的出血并发症（p=0.419）。较大的乳房更有可能接受依诺肝素治疗（p=0.011），但并未导致更高的出血并发症发生率。
在这项回顾性研究中，作者发现乳房重建术的术前化学预防与可接受的术后出血并发症发生率相关。
临床问题/证据水平：治疗性，III 级。
