Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI 53226 USA.
Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI 53226 USA.
J Plast Reconstr Aesthet Surg. 2021 Oct;74(10):2550-2556. doi: 10.1016/j.bjps.2021.03.020. Epub 2021 Mar 29.
Venous thromboembolism (VTE) is a potentially devastating complication following abdominally based microsurgical breast reconstruction, with a reported incidence of 0.08-4%. The authors aim to describe disease presentation and clinical course following VTE diagnosis in patients within their practice.
A retrospective chart review identified patients who underwent microsurgical breast reconstruction from January 2007 through December 2018. Patients with VTE diagnosed within 90 days of surgery were included. Demographics, co-morbidities, signs and symptoms, and characteristics of oncologic, surgical, and post-operative care were analyzed.
Seven hundred one patients underwent microsurgical breast reconstruction. Eleven patients with pulmonary embolism (PE) and four with deep vein thrombosis (DVT) were identified, resulting in VTE incidence of 2.1% (0.57% DVT, 1.6% PE). Patients were on average 51 years old and had an average body mass index (BMI) of 31.7 kg/m2. Two had a history of VTE, and none had a known hypercoagulable disorder. Using the 2005 Caprini model, all were high risk and seven were highest risk. Among those with PE, the most common symptom was shortness of breath, and the most common signs were desaturation or supplemental oxygen requirements. VTE was diagnosed on average 14.2 days post-operatively (range 2-52 days).
VTE is an infrequent complication following abdominally based microsurgical breast reconstruction. We recommend a high index of suspicion in women reporting shortness of breath or having desaturation, especially in those with high BMI, high Caprini scores, post-operative complications, or early return to the operating room.
静脉血栓栓塞症（VTE）是腹部微创乳房重建后一种潜在的严重并发症，其发病率为 0.08%-4%。作者旨在描述他们治疗实践中 VTE 诊断后患者的疾病表现和临床过程。
回顾性病历分析确定了 2007 年 1 月至 2018 年 12 月期间接受微创乳房重建的患者。将术后 90 天内诊断为 VTE 的患者纳入研究。分析了患者的人口统计学、合并症、体征和症状以及肿瘤学、手术和术后护理的特点。
701 例患者接受了微创乳房重建。发现 11 例患者患有肺栓塞（PE），4 例患者患有深静脉血栓形成（DVT），VTE 的发生率为 2.1%（DVT 为 0.57%，PE 为 1.6%）。患者平均年龄为 51 岁，平均体重指数（BMI）为 31.7kg/m2。其中 2 例有 VTE 病史，无已知易栓症。使用 2005 年 Caprini 模型，所有患者均为高危，其中 7 例为最高危。在患有 PE 的患者中，最常见的症状是呼吸急促，最常见的体征是低氧血症或需要补充氧气。VTE 的平均诊断时间为术后 14.2 天（范围为 2-52 天）。
VTE 是腹部微创乳房重建后的一种罕见并发症。我们建议对报告呼吸急促或出现低氧血症的女性保持高度警惕，尤其是那些 BMI 较高、Caprini 评分较高、术后并发症较多或早期返回手术室的患者。
