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Microvascular tissue transfer in a pregnant patient
1Department of Surgery, Allegheny University of the Health Sciences, MCP--Hahnemann School of Medicine, Philadelphia, Pennsylvania 19129, USA.
Journal of Reconstructive Microsurgery
|September 12, 1998
Summary
This case study shows successful microvascular surgery in a pregnant patient with a severe leg injury. Careful management of the pregnancy-associated hypercoagulable state ensured a positive outcome for both mother and fetus.
Area of Science:
- Reconstructive Surgery
- Obstetrics
- Vascular Surgery
Background:
- Pregnancy presents unique challenges for surgical interventions, particularly microvascular procedures, due to the hypercoagulable state.
- Elective surgery is generally deferred during pregnancy due to maternal and fetal safety concerns.
Observation:
- A 35-year-old, 20-week pregnant patient with a Gustilo IIIB open distal tibia/fibula fracture and degloved foot/ankle underwent microvascular salvage.
- A combined latissimus dorsi-serratus anterior free flap with a saphenous vein graft to the popliteal vessels was performed.
- The patient exhibited a significant hypercoagulable state with extensive platelet aggregation, requiring substantial heparinization.
Findings:
- The microvascular tissue transfer successfully salvaged the patient's leg.
- Postoperative management included intravenous dextran and heparin, followed by subcutaneous heparin until delivery.
- The patient delivered a healthy baby, and the flap survived.
Implications:
- This case highlights the feasibility of complex microvascular reconstruction in pregnancy despite hypercoagulability.
- Aggressive thromboprophylaxis strategies are crucial for managing pregnancy-associated hypercoagulable states during such procedures.
- Successful limb salvage in pregnant patients underscores the importance of individualized surgical decision-making.