Microsurgical breast reconstruction and primary hypercoagulable disorders.

Area of Science:

• Microsurgery
• Plastic Surgery
• Hematology

Background:

• Primary hypercoagulable disorders present challenges in microsurgery, traditionally contraindicating free tissue transfer.
• Free flaps offer advantages in breast reconstruction, necessitating expanded criteria for patient selection.
• This study evaluates a chemoprophylaxis regimen for hypercoagulable patients undergoing breast reconstruction.

Observation:

• A retrospective review included 15 patients (25 flaps) with primary hypercoagulability and 785 controls (1268 flaps).
• Hypercoagulable conditions included Factor V Leiden mutation, Protein S deficiency, prothrombin mutation, and antiphospholipid syndrome.
• Patients received extended low-molecular-weight heparin (LMWH) postoperatively.

Findings:

• No significant difference in postoperative venous thromboembolism (VTE), mortality, hematoma, or transfusion rates compared to controls.
• Flap loss rate was 4% in the hypercoagulable group versus 0.92% in controls (p=0.15).
• Salvage rates for arterial or venous compromise were significantly lower in the hypercoagulable group (0% vs. 52%).

Implications:

• Microsurgical breast reconstruction is feasible in hypercoagulable patients with acceptable flap loss rates.
• Extended LMWH prophylaxis appears safe for this population.
• Poor salvage potential highlights the need for careful patient selection and surgical technique.