From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine.
Plast Reconstr Surg. 2019 Apr;143(4):840e-847e. doi: 10.1097/PRS.0000000000005473.
Postsurgical venous thromboembolism remains a leading cause of hospital morbidity. Data to support venous thromboembolism prophylaxis guidelines in lower extremity flap surgery are lacking. The purpose of this study was to explore the effect of pedicled lower extremity flap harvest on venous thromboembolism development in the setting of abdominal or perineal reconstruction.
One hundred twenty-six patients undergoing unilateral lower extremity flap harvest for abdominal or perineal reconstruction were included. The contralateral leg served as an internal control. Sixty comorbidity-matched patients who underwent abdominal/perineal resection without flap reconstruction provided an external control. Bivariate analyses included chi-square and t tests; logistic regression adjusted for confounding variables on venous thromboembolism development.
All patients underwent flap reconstruction for an oncologic defect of the abdomen or perineum, with 80 percent undergoing perineal reconstruction. Most patients underwent anterolateral thigh (41 percent) or gracilis flap (40 percent) harvest. Eleven patients developed deep venous thromboses in one or more legs (9 percent): 10 of 11 (90.9 percent) in the donor extremity and five (45.5 percent) contralaterally (p = 0.022). Patients who underwent flap harvest had a 10-fold higher odds of venous thromboembolism formation when compared to comorbidity-matched controls without flap reconstruction (OR, 10.64; 95 percent CI, 1.11 to 102.34; p = 0.041).
The rate of venous thromboembolism is higher than previously appreciated for reconstructive procedures of the abdomen and/or perineum that use pedicled lower extremity flaps-particularly in the operative extremity. Additional research can clarify the role for further prophylaxis or screening.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
术后静脉血栓栓塞仍然是导致医院发病率的主要原因。缺乏下肢皮瓣手术中静脉血栓栓塞预防指南的数据。本研究的目的是探讨在腹部或会阴部重建中，游离下肢皮瓣采集对静脉血栓栓塞发展的影响。
纳入 126 例单侧下肢皮瓣采集用于腹部或会阴部重建的患者。对侧腿作为内部对照。60 例匹配的共病患者接受腹部/会阴部切除术但无皮瓣重建作为外部对照。双变量分析包括卡方检验和 t 检验；逻辑回归调整静脉血栓栓塞发展的混杂变量。
所有患者均因腹部或会阴部的肿瘤缺陷接受皮瓣重建，80%的患者接受会阴部重建。大多数患者接受前外侧大腿（41%）或股薄肌皮瓣（40%）采集。11 例患者（9%）在一条或多条腿中发生深静脉血栓形成：11 例中的 10 例（90.9%）在供体肢体中，5 例（45.5%）在对侧肢体中（p=0.022）。与未行皮瓣重建的共病匹配对照组相比，行皮瓣采集的患者静脉血栓栓塞形成的几率高 10 倍（OR，10.64；95%CI，1.11 至 102.34；p=0.041）。
与使用游离下肢皮瓣的腹部和/或会阴部重建术相比，该术式的静脉血栓栓塞发生率高于以往的认识——尤其是在手术肢体中。进一步的研究可以阐明进一步预防或筛查的作用。
临床问题/证据水平：治疗性，III 级。
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