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Aim: Venous thromboembolism (VTE) rates in vaginal pelvic organ prolapse (POP) repair are low. Our aim is to evaluate specific risk factors for VTE in patients undergoing vaginal POP repair. Methods: This is a cross-sectional study using the American College of Surgeons NSQIP database. Using CPT codes, cases of vaginal POP repair between 2014 and 2017 were identified. Patient and operative characteristics were collected. VTE was defined as pulmonary embolism (PE) or deep vein thrombosis (DVT) within 30 days from surgery. Univariate analyses were performed using the Student t test for continuous and χ 2 tests for categorical variables. Multivariate logistic regression was performed to identify factors independently associated with VTE. Results: Of 44 207 women who underwent vaginal POP repair, there were 69 cases of VTE (0.16%). VTE rates for obliterative (0.15%) and functional (0.16%) vaginal POP repair, as well as for repairs with hysterectomy (0.17%) and without hysterectomy (0.12%) were not significantly different (p = .616 and .216, respectively). Multivariate analysis demonstrated predictors for postoperative VTE to be ASA physical status classification ≥ 3 (aOR, 1.99; p = .014), length of stay >75th percentile (aOR, 2.01; p = .007), operative time >3 h (aOR, 2.24; p = .007), and dyspnea (aOR, 3.26, p = .004). Conclusion: Despite the low incidence of VTE after vaginal POP repair, patients with ASA physical status classification ≥ 3, length of stay >75th percentile, operative time >3 h, and dyspnea were at higher risk for VTE. Vaginal POP repair may have independent VTE risk factors not captured in standard risk assessment tools. K E Y W O R D S deep vein thrombosis, pelvic organ prolapse, perioperative management, pulmonary embolism, vaginal repair of pelvic organ prolapse, venous thromboembolism, venous thromboembolism prophylaxis

Over the past 35 years, our institution has seen a significant evolution in free flap-based breast reconstruction. Besides a massive increase in flap numbers we have seen a significant trend toward bilateral reconstructions and perforator-based flaps.

PURPOSE: Review trends in posttraumatic microvascular lower extremity reconstructions at a single academic center. METHODS:A prospectively maintained microvascular registry was queried for patient and operative variables. RESULTS:Between 1976 and 2014 651 free flaps were performed for lower extremity trauma reconstruction. 75% of patients were male with a mean age of 37. Case volume peaked by the 1980's and then significantly declined in the mid 1990's. The frequency of muscle flaps and fasciocutaneous flaps has been divergent, with muscle flaps the predominant choice into the 2000's, following an initial period of exclusive groin flap usage. Over the past five years this trend has reversed, with 80% of reconstructions now utilizing fasciocutaneous flaps. Subset analysis demonstrates that the popularity fasciocutaneous flaps correlates to distinct "flap eras", starting with the groin flap, followed by the parascapular flap, and most recently the ALT. CONCLUSION:The significant decrease in posttraumatic lower extremity free flaps at our institution over the past twenty years may represent changing injury or referral patterns, increased flap success, and use of nonfree flap adjuncts such as wound vacs. Recognition of the advantages of the ALT for this indication correlates with an era of fasciocutaneous based reconstruction.

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