Despite appropriate surgical technique and follow-up, flap failures can be encountered for which no valid reason is evident. Current literature states that these unpredictable flap failures can be caused by unknown patient factors, such as undiagnosed hypercoagulability. Our approach and experience utilizing an algorithm to minimize unpredictable failures in microvascular breast reconstruction by predetermining hypercoagulation risk factors in preoperative patients is presented. A prospective assessment of microsurgical breast reconstruction candidates between October 2007 and December 2010 was conducted. Patients were questioned about their tendency toward hypercoagulation. A thrombophilia panel was requested for patients confirming any risk factors. Appropriate surgical planning was conducted according to results of the panel. Of the 60 patients thoroughly questioned about hypercoagulation tendency, 21 (35%) confirmed having prothrombotic tendency and were referred to the thrombophilia testing. The results indicated hypercoagulation in 9 (15%) patients. The primary reconstruction plan of utilizing free flaps was abandoned for these patients and pedicled flaps or implants were preferred for reconstruction. These percentages emphasize the value of questioning risk factors and testing for hypercoagulation in patients seeking microsurgical breast reconstruction. We believe that detailed preoperative questioning of risk factors and appropriate testing according to prothrombotic tendency is beneficial in minimizing unpredictable flap failures and increasing rates of success.

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PurposeThe treatment of Mason type II fractures is controversial, and the aim of our study is to define the outcome of surgical treatment with screw fixation in the Mason type II radial head fracture.MethodsThe study was carried out between 2011 and 2015, and included 14 men and 9 women, with isolated Mason type II radial head fractures which were treated operatively with screw fixation. Cases involving the additional ligament injury or fractures in other areas, or having a follow-up period which is greater than 11 months were excluded. The clinical and radiological results of our patients were assessed, using the Mayo Elbow Performance Score (MEPS).ResultsThe average MEPS was 95.86 points. 100 degree arcs of motion were attained by a total of 21 patients (91 %) for both flexion–extension and pronation–supination. Nevertheless, 2 patients (9 %) did not recover the 100 degree arcs for the flexion–extension.ConclusionAnatomical reduction of type II radial head fractures through open surgery and fixation with screws can have favorable results.Level of evidenceLevel IV, Retrospective design.

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