From the Division of Plastic and Reconstructive Surgery and the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine.
Plast Reconstr Surg. 2021 Jul 1;148(1):14e-18e. doi: 10.1097/PRS.0000000000008099.
Autologous breast reconstruction has evolved considerably from pedicled muscle-based approaches to microsurgical perforator-based techniques. Patients with documented coagulopathy, however, remain a particularly challenging population. The authors present their experience in microsurgical breast reconstruction in patients with coagulopathy and discuss their treatment protocol. A prospectively maintained database was queried for patients with coagulopathy who underwent microsurgical breast reconstruction between 2016 and 2019. Information regarding patient demographics, type of coagulopathy, and anticoagulation regimen were retrieved, and clinical outcomes were investigated. Nineteen patients who underwent 34 microsurgical breast reconstructions with free abdominal flaps were included in the study. The most common coagulopathy was factor V Leiden [n = 7 (38.6 percent)]. Nine patients (47.4 percent) developed thrombotic complications (the majority occurring intraoperatively); notably, arterial and venous thrombosis in four (21.1 percent) and two patients (10.5 percent), respectively. Postoperative thrombotic complications included pulmonary embolism [n = 2 (10.5 percent)] and flap congestion secondary to venous thrombosis [two flaps (5.9 percent)]. Only one flap loss was observed secondary to delayed venous thrombosis on postoperative day 6 (2.9 percent). The anticoagulation regimen in the majority of patients consisted of intraoperative intravenous administration of heparin (2000 U [bolus]) followed by a 5-day heparin infusion at 500 U/hour [n = 10 (52.6 percent)]. The high rate of thrombotic complications in patients with coagulopathy who underwent microsurgical breast reconstruction is contrasted by a low flap loss rate. Although coagulopathy is a risk factor for thrombotic complications, successful microsurgical breast reconstruction is still possible in the majority of patients.
自体乳房重建已从带蒂肌皮瓣方法发展为基于微血管游离穿支皮瓣的技术。然而，有明确凝血障碍的患者仍然是一个极具挑战性的群体。作者介绍了他们在凝血障碍患者中进行显微乳房重建的经验，并讨论了他们的治疗方案。通过前瞻性维护的数据库，检索了 2016 年至 2019 年间接受显微乳房重建的凝血障碍患者的信息。检索了患者的人口统计学资料、凝血障碍类型和抗凝治疗方案，并调查了临床结果。本研究纳入了 19 例接受游离腹部皮瓣显微乳房重建的患者，共进行了 34 次手术。最常见的凝血障碍是因子 V 莱顿突变（n = 7，38.6%）。9 例（47.4%）患者发生血栓并发症（大多数发生在手术期间）；值得注意的是，4 例（21.1%）和 2 例（10.5%）患者分别出现动脉和静脉血栓形成。术后血栓并发症包括肺栓塞（n = 2，10.5%）和静脉血栓形成导致的皮瓣淤血（2 个皮瓣，5.9%）。只有 1 例皮瓣因术后第 6 天发生静脉迟发性血栓形成而丢失（2.9%）。大多数患者的抗凝方案包括术中静脉注射肝素（2000 U [推注]），然后在术后 5 天以 500 U/小时的速度静脉输注肝素[10 例（52.6%）]。凝血障碍患者行显微乳房重建后血栓并发症发生率高，但皮瓣丢失率低。尽管凝血障碍是血栓并发症的危险因素，但在大多数患者中仍可成功进行显微乳房重建。
