Zavlin Dmitry, Chegireddy Vishwanath, Jubbal Kevin T, Agrawal Nikhil A, Spiegel Aldona J
Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas, United States.
Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California, United States.
J Reconstr Microsurg. 2019 Mar;35(3):198-208. doi: 10.1055/s-0038-1670683. Epub 2018 Sep 19.
Maintaining optimal coagulation is vital for successful microvascular tissue transfer. The viscoelastic thromboelastography (TEG) is a modern and dynamic method to assess a patient's coagulation status. The aim of this study was to evaluate its diagnostic capabilities of identifying microvascular complications.
A retrospective chart review was conducted for the most recent 100 cases of abdominal free flap breast reconstruction of a single surgeon. Patient demographics, medical history, clinical, and operative details were documented. Thrombocyte counts, prothrombin time (PT), activated partial thromboplastin time (aPTT), and various TEG parameters were gathered for preoperative, intraoperative, and two postoperative time points.
A total of hundred patients were identified, who underwent 172 abdominal-based free flaps for breast reconstruction. TEG was more dynamic compared with PT or aPTT and demonstrated borderline hypocoagulate values intraoperatively upon unfractionated heparin administration and hypercoagulate values postoperatively. In contrast, PT and aPTT demonstrated a continuously hypocoagulable state. Complications included five thrombotic events and three hematomas. The thrombotic cases had much steeper increases of TEG- between surgery and postoperative day 2 ( = 0.049), while PT and aPTT failed to identify these patients. Of those, two resulted in flap loss (1.2%) that both occurred in patients with abdominal scars from previous surgery.
The TEG is a useful adjunct for monitoring coagulation status in microsurgical breast reconstruction. When thrombosis at the anastomosis occurs, TEG correlates with a more rapid rebound from an intraoperative hypocoagulable state to a postoperative hypercoagulable state, when using the TEG. The TEG is a valuable tool for a more dynamic assessment of the patients' changing coagulation status.
维持最佳凝血状态对于微血管组织移植的成功至关重要。粘弹性血栓弹力图（TEG）是一种评估患者凝血状态的现代动态方法。本研究的目的是评估其识别微血管并发症的诊断能力。
对一位外科医生最近进行的100例腹部游离皮瓣乳房重建病例进行回顾性病历审查。记录患者的人口统计学、病史、临床和手术细节。收集术前、术中及术后两个时间点的血小板计数、凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）和各种TEG参数。
共确定了100例患者，他们接受了172次基于腹部的游离皮瓣乳房重建手术。与PT或aPTT相比，TEG更具动态性，在术中给予普通肝素时显示临界低凝值，术后显示高凝值。相比之下，PT和aPTT显示持续低凝状态。并发症包括5例血栓形成事件和3例血肿。血栓形成病例在手术至术后第2天TEG升高更为陡峭（P = 0.049），而PT和aPTT未能识别这些患者。其中，2例导致皮瓣丢失（1.2%），均发生在有既往腹部手术瘢痕的患者中。
TEG是监测显微外科乳房重建中凝血状态的有用辅助手段。当吻合口发生血栓形成时，使用TEG时，TEG与从术中低凝状态到术后高凝状态的更快反弹相关。TEG是更动态评估患者不断变化凝血状态的有价值工具。
