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Can rotational thromboelastometry predict thrombotic complications in reconstructive microsurgery?

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Rotational thromboelastometry (RTE) can identify patients at risk for thrombotic flap loss in reconstructive microsurgery. A hypercoagulable RTE assay and a high fibrinogen to platelet ratio predict these dangerous complications.

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Area of Science:

  • Reconstructive Microsurgery
  • Hemostasis and Thrombosis
  • Point-of-Care Diagnostics

Background:

  • Flap loss in reconstructive microsurgery is frequently caused by microvascular pedicle thrombosis.
  • Identifying patients at high risk for such thrombotic events is crucial for successful surgical outcomes.
  • Rotational thromboelastometry (RTE) is a valuable tool for assessing coagulopathy and hypercoagulable states.

Purpose of the Study:

  • To evaluate the diagnostic utility of preoperative Rotational Thromboelastometry (RTE) in predicting thrombotic complications after free tissue transfer.
  • To determine if RTE parameters can serve as predictive markers for microvascular pedicle thrombosis and subsequent flap loss.

Main Methods:

  • Preoperative RTE was performed on 181 patients undergoing free tissue transfer.
  • Coagulation values, demographic data, defect characteristics, flap type, and surgical revisions were recorded.
  • Multivariate binary logistic regression was used to analyze predictors of thrombotic flap loss.

Main Results:

  • 36.5% of patients exhibited a hypercoagulable RTE profile preoperatively.
  • A hypercoagulable RTE assay and a fibrinogen to platelet ratio (FPR) >43 were significant predictors of thrombotic flap loss (p=0.036 and p=0.003, respectively).
  • The overall flap loss rate due to thrombosis was 7.7% (14 patients), with 11 occurring in the hypercoagulable group.

Conclusions:

  • Rotational Thromboelastometry (RTE) can effectively identify patients at increased risk for thrombotic complications in reconstructive microsurgery.
  • RTE may serve as a valuable preoperative screening tool to guide prophylactic strategies and potentially reduce flap loss.
  • The fibrinogen to platelet ratio (FPR) derived from RTE is a strong predictor of thrombotic flap loss.