Cho Eugenia H, Bauder Andrew R, Centkowski Sierra, Shammas Ronnie L, Mundy Lily, Kovach Stephen J, Levin L Scott, Hollenbeck Scott T
Durham, N.C.; and Philadelphia, Pa.
From the Division of Plastic and Reconstructive Surgery, Duke University Health System; and the Division of Plastic Surgery and the Department of Orthopaedic Surgery, University of Pennsylvania Health System.
Plast Reconstr Surg. 2017 Jan;139(1):220-230. doi: 10.1097/PRS.0000000000002893.
Thrombocytosis in patients undergoing lower extremity free tissue transfer may be associated with increased risk of microvascular complications. This study assessed whether preoperative platelet counts predict lower extremity free flap thrombosis.
All patients undergoing lower extremity free tissue transfer at Duke University from 1997 to 2013 and at the University of Pennsylvania from 2002 to 2013 were retrospectively identified. Logistic regression was used to assess whether preoperative platelet counts independently predict flap thrombosis, controlling for baseline and operative factors.
A total of 565 patients underwent lower extremity free tissue transfer, with an overall flap thrombosis rate of 16 percent (n = 91). Elevated preoperative platelet counts were independently associated with both intraoperative thrombosis (500 ± 120 versus 316 ± 144 × 10/liter; p < 0.001) and postoperative thrombosis (410 ± 183 versus 320 ± 143 × 10/liter; p = 0.040) in 215 patients who sustained acute lower extremity trauma within 30 days before reconstruction. In acute trauma patients, preoperative platelet counts predicted a four-fold increased risk of intraoperative thrombosis (cutoff value, 403 × 10/liter; OR, 4.08; p < 0.001) and a two-fold increased risk of postoperative thrombosis (cutoff value, 361 × 10/liter; OR, 2.16; p = 0.005). In patients who did not sustain acute trauma, preoperative platelet counts predicted a four-fold increased risk of intraoperative thrombosis (cutoff value, 352 × 10/liter; OR, 3.82; p = 0.002).
Acute trauma patients with elevated preoperative platelet counts are at increased risk for lower extremity free flap complications. Prospective evaluation is warranted for guiding risk stratification and targeted treatment strategies.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
接受下肢游离组织移植的患者出现血小板增多症可能与微血管并发症风险增加有关。本研究评估术前血小板计数是否可预测下肢游离皮瓣血栓形成。
回顾性确定1997年至2013年在杜克大学以及2002年至2013年在宾夕法尼亚大学接受下肢游离组织移植的所有患者。采用逻辑回归分析评估术前血小板计数是否能独立预测皮瓣血栓形成，并对基线和手术因素进行控制。
共有565例患者接受了下肢游离组织移植，皮瓣血栓形成的总体发生率为16%（n = 91）。在重建术前30天内遭受急性下肢创伤的215例患者中，术前血小板计数升高与术中血栓形成（500 ± 120对316 ± 144×10/升；p < 0.001）和术后血栓形成（410 ± 183对320 ± 143×10/升；p = 0.040）均独立相关。在急性创伤患者中，术前血小板计数预测术中血栓形成风险增加四倍（临界值，403×10/升；OR，4.08；p < 0.001），术后血栓形成风险增加两倍（临界值，361×10/升；OR，2.16；p = 0.005）。在未遭受急性创伤的患者中，术前血小板计数预测术中血栓形成风险增加四倍（临界值，352×10/升；OR，3.82；p = 0.002）。
术前血小板计数升高的急性创伤患者发生下肢游离皮瓣并发症的风险增加。有必要进行前瞻性评估以指导风险分层和靶向治疗策略。
临床问题/证据级别：风险，III级
