Microvascular free tissue transfer in the setting of COVID-19 associated coagulopathy: A case report

Nassar, Amer H.; Maselli, Amy; Dowlatshahi, Arriyan S.

doi:10.1016/j.orthop.2021.02.002

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…37,38 It is yet to be thoroughly studied whether previous or active COVID-19 infection affects free-flap survival though several anecdotal case reports do exist. [39][40][41][42] Although the ACS-NSQIP database does not account for COVID-19 status, it is possible that patients who become infected in the early postoperative period may be at increased risk of microvascular thrombosis and flap failure and other trends may be identified in future studies.…”

Section: Discussionmentioning

confidence: 99%

Trends of Autologous Free-Flap Breast Reconstruction and Safety during the Coronavirus Disease 2019 Pandemic

Elmer

Bustos

Veeramani

et al. 2023

J Reconstr Microsurg

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Background: Autologous free flap breast reconstruction (ABR) is a valuable surgical option for patients following mastectomy. The COVID-19 pandemic has led to a myriad of factors that have affected access to care, hospital logistics, and post-operative outcomes. This study aims to identify differences in patient selection, hospital course and severity, and post-operative outcomes for patients who underwent ABR during and prior to the COVID-19 pandemic. Methods: Patients undergoing ABR from the ACS-NSQIP 2019-2020 database were analyzed to compare sociodemographics, hospital course, and outcomes over the first post-operative month. Multivariable logistic regression was used to identify factors predictive of complications based on operative year. Results: 3,770 breast free flaps were stratified into two groups based on the timing of reconstruction (pre-pandemic and pandemic groups). Patients with a diagnosis of disseminated cancer were significantly less likely to undergo ABR during the COVID-19 pandemic. On univariate analysis, there were no significant differences in post-operative complications between the two groups. When controlling for potentially confounding sociodemographic and clinical risk factors, the COVID-19 group was significantly more likely to undergo reoperation compared to the pre-pandemic group (p< 0.05). Conclusion: When comparing outcomes for patients who underwent ABR prior to and during the COVID-19 pandemic, we found a significant increase in the odds of reoperation for those who had ABR during the pandemic. Debridement procedures and exploration for postoperative hemorrhage, thrombosis or infection increased from the pre-pandemic group to the COVID-19 group. Notably, operative times decreased.

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Section: Discussionmentioning

confidence: 99%

Trends of Autologous Free-Flap Breast Reconstruction and Safety during the Coronavirus Disease 2019 Pandemic

Elmer

Bustos

Veeramani

et al. 2023

J Reconstr Microsurg

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“…As shown in this case and other reports, free tissue transfer is possible for select patients, despite the hypercoagulability associated with COVID-19. 13,14 Our intention was to attempt conservative wound coverage strategies in the early stages of COVID-19 infection. One report of COVID-19 free tissue transfer recommends delaying reconstruction, and another report of lower extremity free tissue transfer in a patient with COVID-19 and a pilon fracture recommends an extended period of anticoagulation postoperatively, including 3 months of antiplatelet therapy and 6 months of therapeutic anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

“…One report of COVID-19 free tissue transfer recommends delaying reconstruction, and another report of lower extremity free tissue transfer in a patient with COVID-19 and a pilon fracture recommends an extended period of anticoagulation postoperatively, including 3 months of antiplatelet therapy and 6 months of therapeutic anticoagulation. 13,14 Given the asymptomatic course of this patient's COVID-19 infection and the fact that she was more than 6 weeks past her initial positive result, a more conservative regimen consisting of 1 month of aspirin 81 mg and enoxaparin 40 mg daily chemoprophylaxis during bedrest was administered. Our patient's postoperative course was not complicated by sequelae of her COVID-19 infection, and the conservative regimen was successful in preventing any thromboembolic event.…”

Section: Discussionmentioning

confidence: 99%

Lower Extremity Salvage in a Diabetic Patient With Cutaneous Mucormycosis and COVID-19 After Open Patella Fracture

Hammoudi

Morar

Garbuzov

et al. 2022

TOJ

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Background: Cutaneous mucormycosis, while less common than sinonasal or pulmonary infections, can cause widespread tissue necrosis after seemingly innocuous encounters. The most common location of cutaneous mucormycosis is the extremities, and extensive infection has been reported after trauma or orthopedic procedures. Case Report: A 60-year-old female with poorly controlled type 2 diabetes mellitus sustained an open patella fracture after a fall. She underwent washout and internal fixation with cannulated screws and cable tension band wiring. The patient's recovery was complicated by asymptomatic coronavirus disease 2019 (COVID-19) infection and repeated wound dehiscence, with growth of Mucor species initially presumed to be a contaminant. Despite serial washout and debridement, repeat dehiscence and patella exposure were noted. Free tissue transfer to the genicular vessels was selected for coverage of the extensor tendon, patella, and fracture line. In repeat skin cultures, Mucor indicus and Staphylococcus epidermidis grew from the wound. Topical voriconazole and a 6-week course of intravenous isavuconazole and oral doxycycline were started when the Mucor cultures were identified. Conclusion: This case highlights an approach to an indolent mucormycosis infection in the skin over a patella fracture in a patient with poorly controlled diabetes mellitus, including the sequence of surgical care, debridement, and selection of antimicrobials. Major amputation and orthopedic revision were avoided. This patient also underwent successful free tissue transfer after testing positive for COVID-19.

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“…The diameter mismatch between the vessels poses a problem in bringing them together, and the risk of thrombosis is high. Turbulence caused by sudden diameter changes triggers platelet aggregation [ 2 ]. Leakage may occur at anastomotic sites following femoral artery repair.…”

Section: Introductionmentioning

confidence: 99%

The effect of mesenchymal stem cells lyophilisate on femoral artery of rat anastomosis: A histopathological and histomorphometric study

Tutak

Annaç

2021

Annals of Medicine and Surgery

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Background and objective Mesenchymal Stem Cells (MSCs) are well known for their tissue regeneration enhancing effect and their contribution to immune regulation. However, their contribution to the healing process of femoral artery anastomosis, especially to endothelialization, has not been studied sufficiently in the clinic. This study was carried out to evaluate the effects of MSC-lyophilisate from the human umbilical cord on anastomosis experimental study in rats histopathologically. Method After intraperitoneal anesthesia was applied to the rats, the femoral artery was exposed with a 2 cm incision in the right femoral region. After the artery was cut in the experiment and sham groups, femoral artery end-to-end anastomosis was performed using the primary suture technique. MSC-lyophilisate was poured in powder form onto the anastomosed outer surface of the vessel in the treatment group and saline solution was poured to the sham group. No intervention was made to the control group. The data analysis was performed with IBM SPSS Statistics 25. Results In the experiment group, flattening of the inner elastic lamina, morphological changes and vacuolization in the muscle fibers, inflammation in the adventitia and significant vascular wall thickening were observed in the femoral arteries of the rats after the intervention. According to the histopathological scoring results, tissue samples belonging to sham and experimental groups showed marked pathological findings such as endothelial damage, flattened areas where the folded structure in the inner elastic lamina disappeared, muscle fiber degeneration and inflammation in the adventitia. Conclusion Human umbilical cord-origin MSC-lyophilisate application holds an important place in femoral artery surgery. We evaluate that it will be meaningful to determine the MSC-lyophilisate dose for hemostasis without creating thrombus after anastomosis. MSC-lyophilisate will be used to provide hemostasis in areas with local bleeding in the future. In addition, it is recommended to make plans for an in-depth examination of possible problems and cases in future studies.

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Microvascular free tissue transfer in the setting of COVID-19 associated coagulopathy: A case report

Cited by 5 publications

References 11 publications

Trends of Autologous Free-Flap Breast Reconstruction and Safety during the Coronavirus Disease 2019 Pandemic

Trends of Autologous Free-Flap Breast Reconstruction and Safety during the Coronavirus Disease 2019 Pandemic

Lower Extremity Salvage in a Diabetic Patient With Cutaneous Mucormycosis and COVID-19 After Open Patella Fracture

The effect of mesenchymal stem cells lyophilisate on femoral artery of rat anastomosis: A histopathological and histomorphometric study

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