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Hypercoagulability in microvascular breast reconstruction: an algorithmic approach for an underestimated situation
Billur Sezgin1, Suhan Ayhan, Serhan Tuncer
1Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
Journal of Reconstructive Microsurgery
|June 30, 2012
Summary
Preoperative screening for hypercoagulability in breast reconstruction patients can identify risks. Identifying and managing these risks, such as hypercoagulability, improves microsurgical flap success rates.
Area of Science:
- Plastic Surgery
- Vascular Surgery
- Hematology
Background:
- Unpredictable flap failures in microvascular breast reconstruction can occur despite optimal surgical techniques.
- Undiagnosed patient factors, including hypercoagulability, are potential causes for these failures.
Purpose of the Study:
- To present an algorithm for identifying preoperative hypercoagulation risk factors in microvascular breast reconstruction candidates.
- To minimize unpredictable flap failures by predetermining hypercoagulation risk.
Main Methods:
- Prospective assessment of 60 microsurgical breast reconstruction candidates (Oct 2007-Dec 2010).
- Patients were questioned about hypercoagulation tendencies; those with risk factors underwent thrombophilia panel testing.
- Surgical plans were adjusted based on thrombophilia panel results.
Main Results:
- 35% (21/60) of patients reported a prothrombotic tendency and were referred for testing.
- 15% (9/60) of patients were diagnosed with hypercoagulability.
- Free flap reconstruction was avoided in favor of pedicled flaps or implants for patients with hypercoagulability.
Conclusions:
- Preoperative questioning and thrombophilia testing are valuable for identifying hypercoagulability in breast reconstruction candidates.
- Managing identified hypercoagulation risks can minimize unpredictable flap failures and enhance reconstruction success rates.
