Hereditäre Thrombophilie und ihre Bedeutung für die freie mikrovaskuläre Gewebetransplantation anhand einer Falldarstellung

Abstract

Hereditary thrombophilia sums up a large number of haemostatic disorders, which cause thrombosis independently to external influences. The main cases of hereditary thrombophilias are the hereditary antithrombin defect, the activated protein C resistance, the hereditary protein C defect, the hereditary protein S defect, the antiphospholipid antibody syndrome, the hyperhomocysteinaemia, the increased factor VIII activity and the prothrombin-G20210A-polymorphism. We present a patient who was amputated in both breasts due to cancer. A bilateral microvascular TRAM-flap was planned as primary reconstruction on one breast and secondary reconstruction on the other breast. However in the operation the flap vessels revealed irreversible thromboses so that the intended reconstruction could not be completed in this operation. Postoperatively, a combined hereditary thrombophilia was diagnosed: heterocygote activated protein C resistance, antiphospholipid antibody syndrome and hyperhomocysteinaemia.

Thrombotic Occlusion of a Microvascular Anastomosis in a Resistance to Activated Protein C (APC) Patient with Incomplete Wound Healing after High Doses of Ascorbic Acid (Vitamin C)

“…Irreversible thromboses after microvascular anastomosis due to hereditary thrombophilia have been described in the literature [2,3]. Furthermore, we found a former comparable free DIEP flap failure after an irreversible venous thrombosis in another patient with an APC resistance operated in our department.…”

An Appraisal of Internal Mammary Artery Perforators as Recipient Vessels in Microvascular Breast Reconstruction—An Analysis of 515 Consecutive Cases

“…5,6 Furthermore, precise patient medical history and preoperative screening may identify thrombophilia. 7 Standard recipient vessels have also changed. Although earlier, the thoracodorsal artery (TDA) and its branches were the preferred recipient vessels, nowadays, the internal mammary artery (IMA) serves as a standard vessel.…”

Microsurgical Breast Reconstruction in Patients with Disorders of Hemostasis – Perioperative Risks and Management

“…There is currently no consensus on the optimal screening and management strategy for thrombophilic conditions in patients undergoing microvascular breast reconstruction. [12][13][14][15][16][17][18] Although previous recommendations have not supported routine screening, more recent studies have advanced several reasons for more aggressive screening protocols. 14,19 Perioperative hematologic management can help to minimize complications associated with some thrombophilic conditions.…”

“…[24][25][26][27][28] Our indications for thrombophilia screening are based on clinical data, the patient's medical history, including family history recorded on a standardized questionnaire, and on the recommendations of an international expert committee. 12,16,18,29,30 (See Document, Supplemental Digital Content 1, which shows the exemplary screening questionnaire for thromboembolism, http://links.lww.com/PRS/F346.) A hematologist was involved when thrombophilia screening was indicated based on the patient's history, and when the corresponding laboratory screening had to be arranged and interpreted.…”