Badash Ido, Burtt Karen, Leland Hyuma, Gould Daniel, Rounds Alexis, Patel Ketan, Carey Joseph
From the Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA.
Ann Plast Surg. 2019 May;82(5S Suppl 4):S345-S349. doi: 10.1097/SAP.0000000000001871.
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, represents a significant perioperative complication. However, the outcomes of lower extremity salvage in the setting of perioperative VTE are not well reported.
A retrospective review of lower extremity trauma patients requiring soft tissue reconstruction between July 2007 and December 2015 at an urban trauma center was performed. Patients with clinically apparent VTE during inpatient stay were identified. Outcomes compared included success of limb salvage, flap survival, and flap complications. Comorbidities, injury characteristics and perioperative data were also compared between patients with and without VTE.
One hundred ninety patients with lower extremity injuries underwent local and free flap procedures, with 12 (6.3%) patients developing clinically apparent VTE during hospitalization. Nine VTEs (75.0%) were diagnosed prior to soft tissue reconstruction, and 3 (25.0%) VTEs were diagnosed postreconstruction. The limb salvage rate in patients with VTE was 100%. There were no flap losses in patients with VTE, and the overall flap complication rate was similar between VTE and non-VTE groups (P = 0.26). However, there was an increased risk of postoperative hematoma in patients undergoing free flap transfer with diagnosed VTE compared with patients receiving free flaps without VTE (40.0% vs 2.6%, P = 0.02). Additionally, 1 patient died as a result of pulmonary embolism, and another patient experienced an ischemic stroke from a paradoxical embolism.
These results suggest that successful limb salvage and flap survival may be achieved in the setting of perioperative VTE, although anticoagulation prophylaxis and treatment are critical in this population due to significant morbidity and mortality associated with VTE.
静脉血栓栓塞症（VTE），包括深静脉血栓形成和肺栓塞，是一种重要的围手术期并发症。然而，围手术期VTE情况下下肢挽救的结果报道并不充分。
对2007年7月至2015年12月在一家城市创伤中心需要进行软组织重建的下肢创伤患者进行回顾性研究。确定住院期间出现临床明显VTE的患者。比较的结果包括肢体挽救成功、皮瓣存活和皮瓣并发症。还比较了有VTE和无VTE患者的合并症、损伤特征和围手术期数据。
190例下肢损伤患者接受了局部和游离皮瓣手术，其中12例（6.3%）患者在住院期间出现临床明显的VTE。9例VTE（75.0%）在软组织重建前被诊断，3例（25.0%）VTE在重建后被诊断。VTE患者的肢体挽救率为100%。VTE患者没有皮瓣丢失，VTE组和非VTE组的总体皮瓣并发症发生率相似（P = 0.26）。然而，与未诊断VTE的游离皮瓣患者相比，诊断为VTE的游离皮瓣转移患者术后血肿风险增加（40.0%对2.6%，P = 0.02）。此外，1例患者死于肺栓塞，另1例患者因反常栓塞发生缺血性中风。
这些结果表明，在围手术期VTE情况下可能实现成功的肢体挽救和皮瓣存活，尽管由于VTE相关的显著发病率和死亡率，抗凝预防和治疗在该人群中至关重要。
