Free flap thrombosis in patients with hypercoagulability: A systematic review

Abstract

BackgroundEven with satisfactory anastomosis technique and adequate experience of the surgeon, flap loss due to thrombosis can still occur due to the patient’s underlying condition. Patients with hypercoagulability due to etiologies such as malignancy, hereditary conditions, and acquired thrombophilia are among those who could benefit from free flap procedures. This review aimed to evaluate the risk of free flap thrombosis in patients with hypercoagulability and to identify the most effective thromboprophylaxis regimen.MethodsThis review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The PubMed, Embase, and Cochrane Library databases were explored. Types of free flaps, types of hypercoagulable states, thrombosis prevention protocols, thrombosis complication rates, and flap vitality outcomes were reviewed. Samples from the included studies were pooled to calculate the relative risk of free flap thrombosis complications in patients with hypercoagulability compared to those without hypercoagulability.ResultsIn total, 885 articles underwent title, abstract, and full-text screening. Six articles met the inclusion criteria. The etiologies of hypercoagulability varied. The overall incidence of thrombosis and flap loss in hypercoagulable patients was 13% and 10.3%, respectively. The thrombosis risk was two times higher in hypercoagulable patients (P=0.074) than in controls. Thromboprophylaxis regimens were variable. Heparin was the most commonly used regimen.ConclusionsHypercoagulability did not significantly increase the risk of free flap thrombosis. The most effective thromboprophylaxis regimen could not be determined due to variation in the regimens. Further well-designed studies should be conducted to confirm this finding.

Overcoming severe calcified lower extremity artery in lower limb salvage operation by using the Fogarty catheter and vein graft

“…Another approach in free flap reconstruction is catheter-directed or catheter-assisted thrombolysis using heparin, streptokinase, urokinase and recombinant tissue plasminogen activator (rTPA) (Biben & Atmodiwirjo, 2019;Trussler et al, 2008;Tse et al, 2003). can be done.…”

Free Tissue Transfer in Patients with Hematologic Malignancies: A Case Series

“…A patient with partial vein thrombosis in this case series has fibrinogen below 3.5 g/L, but the D-dimer level is above 0.4 μg/mL. A higher survival rate of a flap and minimal complications can be achieved by optimizing the patient medical condition [18,21] Performing free tissue transfer in patients with lymphoma and leukemia is better done during the remission phases of the disease when normal levels of blood cells are achieved [9,10]. Studies suggested consultation with a hematooncologist prior to surgery [18,22].…”

“…His study also showed that the patients not receiving antithrombotic showed a survived flap with a lower risk of bleeding compared to those who received antithrombotic. Until a generally accepted protocol is published, most surgeons selected the antithrombotic regimen due to their results and experiences [21,26]. The most popular antithrombotic agents include aspirin, heparin, lowmolecular-weight heparin (LMWH), and dextran [25,27].…”

Analysis of Factors Determining Patient Survival after Receiving Free-Flap Reconstruction at a Single Center—A Retrospective Cohort Study

“…Potentially, this factor could contribute to the increased number of revision surgeries and flap loss in this study group. Previous data have shown that patients with coagulative diseases need a revision surgery after free flap transfer more frequently compared to healthy patients, also corresponding to higher rates of free flap loss [ 7 , 30 , 31 , 32 ].…”