Imaging and Surgical Principles of the Propeller and Perforator Flaps of the Lower Limb

Cigna, Emanuele; Maruccia, Michele; Napoli, A. Di; Torto, Federico Lo; Parisi, Paola; Ribuffo, Diego

doi:10.1201/b17799-38

Imaging for Plastic Surgery 2014

DOI: 10.1201/b17799-38

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Imaging and Surgical Principles of the Propeller and Perforator Flaps of the Lower Limb

Emanuele Cigna¹,

Michele Maruccia²,

A. Di Napoli³

et al.

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2021

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Cited by 1 publication

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“…In addition to VTE risk, there is also concern for flap or replant failure in this patient population, most commonly occurring due to microvascular thrombosis at the site of anastomosis. 8 9 10 11 To prevent this devastating complication, anticoagulants and antiplatelet agents are administered intraoperatively and/or postoperatively. 12 Practice varies greatly by institution with limited data to support the use of one regimen over another.…”

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confidence: 99%

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Prevention of Venous Thromboembolism in Microvascular Surgery Patients Using Weight-Based Unfractionated Heparin Infusions

Bertolaccini

Prazak

Goodwin

et al. 2021

J Reconstr Microsurg

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Background Unfractionated heparin infusions are commonly used in microvascular surgery to prevent microvascular thrombosis. Previously, fixed-dose heparin infusions were believed to provide sufficient venous thromboembolism (VTE) prophylaxis; however, we now know that this practice is inadequate for the majority of patients. Anti-factor Xa (aFXa) level is a measure of unfractionated heparin efficacy and safety. This study evaluated the pharmacodynamics of weight-based dose heparin infusions and the impacts of real-time aFXa-guided heparin dose adjustments. Methods This prospective clinical trial enrolled adult microvascular surgery patients who received a weight-based heparin dose following a microsurgical procedure. Steady-state aFXa levels were monitored, and patients with out-of-range levels received dose adjustments. The study outcomes assessed were aFXa levels at a dose of heparin 10 units/kg/hour, time to adequate aFXa level, number of dose adjustments required to reach in-range aFXa levels, and clinically relevant bleeding and VTE at 90 days. Results Twenty-one patients were prospectively recruited, and usable data were available for twenty patients. Four of twenty patients (20%) had adequate prophylaxis at a heparin dose of 10 units/kg/hour. Among patients who received dose adjustments and achieved in-range aFXa levels, the median number of dose adjustments was 2 and the median weight-based dose was 11 units/kg/hour. The percentage of patients with in-range levels was significantly increased (65 vs. 15%, p = 0.0002) as a result of real-time dose adjustments. The rate of VTE at 90 days was 0%, and clinically relevant bleeding rate at 90 days was 15%. Conclusion Weight-based heparin infusions at a rate of 10 units/kg/hour provide a detectable level of anticoagulation for some patients following microsurgical procedures, but most patients require dose adjustment to ensure adequate VTE prophylaxis.

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mentioning

confidence: 99%

“…12 Practice varies greatly by institution with limited data to support the use of one regimen over another. 9 13…”

mentioning

confidence: 99%

Prevention of Venous Thromboembolism in Microvascular Surgery Patients Using Weight-Based Unfractionated Heparin Infusions

Bertolaccini

Prazak

Goodwin

et al. 2021

J Reconstr Microsurg

View full text Add to dashboard Cite

show abstract

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Imaging and Surgical Principles of the Propeller and Perforator Flaps of the Lower Limb

Cited by 1 publication

References 187 publications

Prevention of Venous Thromboembolism in Microvascular Surgery Patients Using Weight-Based Unfractionated Heparin Infusions

Prevention of Venous Thromboembolism in Microvascular Surgery Patients Using Weight-Based Unfractionated Heparin Infusions

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