Venous thromboembolism in plastic surgery: incidence, current practice and recommendations

Area of Science:

• Plastic Surgery
• Thromboembolism Research
• Evidence-Based Medicine

Background:

• Venous thromboembolic events (VTEs) present diagnostic and treatment challenges due to often asymptomatic presentations and significant morbidity.
• The true incidence of VTEs is unclear, compounded by a lack of standardized screening and prophylaxis protocols in plastic surgery patients.

Purpose of the Study:

• To identify existing thromboprophylactic recommendations within the plastic surgery literature.
• To review current knowledge on thromboembolism and prophylaxis methods relevant to plastic surgery.

Main Methods:

• A systematic evaluation of published guidelines for thromboembolism prophylaxis in plastic surgery was performed.
• Studies were analyzed based on their support for or against mechanical and/or pharmacological prophylaxis.

Main Results:

• Twenty-four studies favored prophylaxis, while three opposed it.
• The evidence base primarily consists of lower-grade studies (Grade C, Level IV/V), with a significant lack of high-quality (Grade A/B) evidence.
• Recommendations originated from various sources including randomized trials, retrospective studies, reviews, surveys, and expert opinions.

Conclusions:

• There is a notable scarcity of high-quality evidence supporting thromboprophylaxis in plastic surgery.
• Further research is essential to establish robust, evidence-based guidelines for thromboprophylaxis in plastic and reconstructive surgery.