Prevention and Treatment of Thrombosis in Microvascular Surgery

Hanasono, Matthew M.; Butler, Charles E.

doi:10.1055/s-2008-1080530

Cited by 73 publications

(52 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[38–40] Flap loss resulting from thrombosis can contribute to additional operations and poor outcomes; therefore, efforts to minimize these complications are essential. [41] Based on overwhelming evidence tamoxifen increases the risk of systemic thromboembolic events in patients with breast cancer, there have been concerns a potentially prothrombotic environment would similarly increase the risk of flap thrombotic events. In 2012, Kelley, et al lent this credibility by demonstrating an increased risk of flap loss and a lower rate of flap salvage for patients on tamoxifen undergoing microvascular reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Tissue factor is a principal initiator of the extrinsic pathway of coagulation, resulting in fibrin production which polymerizes to form a clot and strengthens the initial platelet plug. [41,56] This combination of fibrin production and platelet activation/aggregation are central events in arterial and venous thrombosis by contributing to intimal hyperplasia, smooth muscle cell degeneration, and formation of intraluminal thrombi at the anastomotic site. [41,57–59,40,60] The role of tamoxifen in increasing platelet activation and aggregation is considered the primary mechanism by which it induces a prothrombotic environment in patients with breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…[41,56] This combination of fibrin production and platelet activation/aggregation are central events in arterial and venous thrombosis by contributing to intimal hyperplasia, smooth muscle cell degeneration, and formation of intraluminal thrombi at the anastomotic site. [41,57–59,40,60] The role of tamoxifen in increasing platelet activation and aggregation is considered the primary mechanism by which it induces a prothrombotic environment in patients with breast cancer. Recently, investigators demonstrated tamoxifen promotes calcium entry into platelets, which is critical to platelet activation and aggregation, and may lead to prothrombotic platelet phenotypes in breast cancer patients on hormone therapy.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Complications and thromboembolic events associated with tamoxifen therapy in patients with breast cancer undergoing microvascular breast reconstruction: a systematic review and meta-analysis

Parikh

Odom

et al. 2017

Breast Cancer Res Treat

View full text Add to dashboard Cite

Purpose Tamoxifen therapy is integral in the treatment of patients with hormone receptor-positive breast cancer. However, there is an association between tamoxifen and thromboembolic events. Flap and systemic thromboembolic events have devastating consequences in microvascular breast reconstruction. Currently, there is conflicting data on the association between tamoxifen therapy and thromboembolic complications for patients undergoing microvascular breast reconstruction. The objective of this study is to determine if perioperative tamoxifen therapy modifies the risk of complications and thromboembolic events for patients with breast cancer undergoing microvascular breast reconstruction. Methods A comprehensive literature search was performed across 6 databases from January 2003 to February 2016. Pooled estimates and relative risk (RR) were calculated using a random-effects model, confounding was examined with meta-regression, and risk of bias was evaluated. Primary outcomes were thrombotic flap complications and total flap loss. Study quality was assessed using Downs and Black criteria. Results Of 95 studies reviewed, 4 studies comprising 1700 patients and 2245 procedures were included for analysis. Compared to non-recipients, patients on tamoxifen were at increased risk of developing thrombotic flap complications (pooled RR: 1.5; 95% CI: 1.14–1.98) and total flap loss (pooled RR: 3.35; 95% CI: 0.95–11.91). There was no significant heterogeneity present in either outcome and no evidence of publication bias. Conclusions Perioperative tamoxifen therapy may increase the risk of thrombotic flap complications and flap loss for patients with breast cancer undergoing microvascular reconstruction. These findings further the ability of providers to make evidence-based recommendations in the perioperative management of patients with breast cancer.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Complications and thromboembolic events associated with tamoxifen therapy in patients with breast cancer undergoing microvascular breast reconstruction: a systematic review and meta-analysis

Parikh

Odom

et al. 2017

Breast Cancer Res Treat

View full text Add to dashboard Cite

show abstract

“…The ratio of vascular thrombosis reported in free flap surgery varies between 5.1% and 9.9% (11-13), and for the prevention of this complication, in addition to the suggestions of agents such as botulinum toxins, low molecular weight heparins, aspirin, prostaglandins, dextran inhibitors, and other various agents (14)(15)(16)(17)(18)(19)(20)(21)(22), studies on anastomosis have also been carried out (23)(24)(25)(26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

An Attempt to Keep Flaps Alive with Artificial Perfusion in Rabbits

Özyazgan¹,

Idaci²,

Kontaş³

2016

Erciyes Med J

View full text Add to dashboard Cite

Objective: In free flap surgery, the condition of recipient vessels may not be appropriate for anastomosis because of anatomical factors or acquired features such as tumoral invasion, surgical treatment, or radiotherapy. Furthermore, free flap surgery is time-consuming, expensive, demanding, and more prone to complications. The aim of this study was to test the hypothesis that maintaining free flap perfusion with a temporary artificial system without microanastomosis until revascularization is adequate for flap vitality. Materials and Methods:We studied a total of 14 rabbits, which were placed into two groups: control and experimental. A 5×5 cm free skin island flap was elevated on the caudolateral scapular region. In the experimental group, the artery and vein of the flaps were cannulated and a 5 cc/h plasma infusion was artificially started prior to flap fixation. In the control group, the flaps were designed and sutured to the recipient area without perfusion.Results: The animals did not live long enough for us to analyze the maintenance of the clinical flap vitality. However, it was found that flap tissues in the experimental group were vital during the first 6 days after surgery, while composite graft tissues in the control group resulted in necrosis on day 3 in histopathological examination.Conclusion: Our experimental model proves that the artificial flap perfusion model with plasma perfusion extends the duration of tissue viability compared with that with non-perfusion (control group). This result could be improved with further investigations and may lead to the development of many future innovations.

show abstract

“…Die Regimes sind weltweit äußerst divergent und lehnen sich am ehesten an koronarchirurgische Standards der Thromboseprophylaxe mit vorrangigem Einsatz von Heparin an [22].…”

Section: Lappentransplantate Und Weichteileingriffe: Management Von Punclassified

Postoperative Komplikationen in der plastischen Chirurgie

Vogt

2009

Chirurg

View full text Add to dashboard Cite

Plastic surgery covers a broad spectrum of diseases and conditions in the areas of reconstructive surgery, hand, burn and aesthetic surgery. Besides acquired defects or malformations an increasing number of patients are being treated for surgical or multimodal complications. In a considerable number of patients plastic and reconstructive surgery remains the only therapeutic alternative after other therapy has failed. Therefore complication management in plastic surgery is of utmost importance for a successful outcome. In addition patient expectations in the results of plastic surgery as a discipline of invention and problem solving are steadily increasing. This challenge is reflected in clinical patient management by intensive research in tissue engineering and regenerative medicine. Patients in plastic surgery are recruited from all age groups of either gender, involving traumatic and oncologic as well as congenital and aesthetic disorders. The demographics of aging, multimorbidity and obesity pose new challenges to plastic surgery. Although age over 70 years is not an independent risk factor per se for complications in plastic surgery, e.g. for complex free flap transfer, medical problems are present at a higher rate, which is to be expected in this age group. Risk factors such as alcoholism and coronary heart diseases seem to be independent predictors of perioperative complications. Therefore older patients can also benefit from plastic surgery and recurrent operations by the corresponding risk and complication management. Complication management necessitates careful patient selection, estimation of operative risks and patient-adapted selection of procedures. In addition to expertise in plastic surgery a thorough knowledge of non-surgical and surgical back-up procedures for technical incidents as well as vascular circulatory and wound healing disorders is required to deal successfully with complications in plastic surgery. This article presents these specific aspects of postoperative complication management in plastic surgery.

show abstract

Prevention and Treatment of Thrombosis in Microvascular Surgery

Cited by 73 publications

References 44 publications

Complications and thromboembolic events associated with tamoxifen therapy in patients with breast cancer undergoing microvascular breast reconstruction: a systematic review and meta-analysis

Complications and thromboembolic events associated with tamoxifen therapy in patients with breast cancer undergoing microvascular breast reconstruction: a systematic review and meta-analysis

An Attempt to Keep Flaps Alive with Artificial Perfusion in Rabbits

Postoperative Komplikationen in der plastischen Chirurgie

Contact Info

Product

Resources

About