Claytor R Brannon, Tolan Grace, Pettibone Trevor, Fisher Alec
Aesthet Surg J Open Forum. 2025 Apr 16;7:ojaf024. doi: 10.1093/asjof/ojaf024. eCollection 2025.
Because the desire for body contouring rises exponentially, the rate of abdominoplasty continues to increase. Although this procedure provides patients with aesthetically pleasing results, pulmonary embolism (PE) represents a potentially fatal risk surgeons seek to avoid with risk stratification and prophylaxis based on the 2005 Caprini risk assessment model (RAM). Despite the efforts of the American Society of Plastic Surgery task force, much uncertainty exists on the appropriate venous thromboembolism (VTE) prophylaxis.
The aim of this study is to demonstrate the safety and efficacy of utilizing a comprehensive mechanical and chemoprophylaxis protocol to prevent VTE in abdominoplasty.
This was a retrospective study reviewing 1 surgeon's (R.B.C.) postoperative complications for 333 patients who underwent abdominoplasty, belt lipectomy, or modified float tummy tuck from January 2017 to April 2024. All patients received chemoprophylaxis consisting of preoperative heparin injection, intraoperative intermittent pneumatic compression (IPC) devices, 1 week of postoperative enoxaparin injections and home IPCs for 2 weeks. All patients were preoperatively screened using the 2005 Caprini RAM; high-risk patients (≥6) continued enoxaparin injections for 1 month postoperatively.
The median 2005 Caprini score was 4. There were 34 (10.2%) complications postoperatively: 2 (0.60%) PEs, 5 (1.50%) seromas, 6 (1.80%) hematomas, 3 (0.90%) wound healing complications, and 12 (3.60%) wound infections. The PE events occurred in patients with a 2005 Caprini score of 4.
The 2005 Caprini RAM provides a framework to guide VTE prophylaxis; however, patients with low/moderate-risk scores may suffer deep vein thrombosis (DVT) or PE. The authors demonstrate that a comprehensive mechanical and chemoprophylaxis protocol reduced the incidence of VTE compared with the literature and did not increase the risk of bleeding or complication.
由于对身体塑形的需求呈指数级增长，腹壁成形术的施行率持续上升。尽管该手术能为患者带来美观的效果，但肺栓塞（PE）是一种潜在的致命风险，外科医生试图依据2005年卡普里尼风险评估模型（RAM）进行风险分层和预防来避免。尽管美国整形外科协会特别工作组付出了努力，但对于适当的静脉血栓栓塞（VTE）预防措施仍存在诸多不确定性。
本研究旨在证明采用综合机械和化学预防方案预防腹壁成形术中VTE的安全性和有效性。
这是一项回顾性研究，回顾了1位外科医生（R.B.C.）在2017年1月至2024年4月期间为333例行腹壁成形术、腰部脂肪切除术或改良漂浮腹壁整形术患者的术后并发症情况。所有患者均接受化学预防，包括术前肝素注射、术中间歇性气动压迫（IPC）装置、术后1周的依诺肝素注射以及术后2周的家庭IPC。所有患者术前均使用2005年卡普里尼RAM进行筛查；高危患者（≥6分）术后继续依诺肝素注射1个月。
2005年卡普里尼评分中位数为4分。术后有34例（10.2%）并发症：2例（0.60%）PE、5例（1.50%）血清肿、6例（1.80%）血肿、3例（0.90%）伤口愈合并发症以及12例（3.60%）伤口感染。PE事件发生在2005年卡普里尼评分为4分的患者中。
2005年卡普里尼RAM提供了一个指导VTE预防的框架；然而，低/中度风险评分的患者仍可能发生深静脉血栓形成（DVT）或PE。作者表明，与文献相比，综合机械和化学预防方案降低了VTE的发生率，且未增加出血或并发症风险。
