Reactive Thrombocytosis Alone Does Not Affect the Patency of Microvascular Anastomosis in the Splenectomy Rat

Abstract

Vascular thrombosis is a harbinger of failure in microsurgery. However, there is still controversy regarding the correlation of the complications of thrombocytosis and thrombosis. Some evidence indicates that patients with elevated platelet counts tend to have a higher flap failure rate, and surgeons usually hesitate to operate on patients with thrombocytosis. Nevertheless, the authors have experienced successful free tissue transfer in seven patients with thrombocytosis resulting from traumatic splenectomy or multiple trauma. On the basis of clinical observation, the authors investigated whether reactive thrombocytosis contributes to the patency of a microvascular anastomosis. In a rodent splenectomy-induced thrombocytosis model (n = 40), stable reactive thrombocytosis occurred after postoperative days 5 to 10, with the peak on postoperative day 7. Femoral artery division and reanastomosis was performed in rats with or without splenectomy-induced thrombocytosis, and vascular patency was assessed. Platelet counts and platelet activation were studied in correlation to microvascular patency. Platelet activation as demonstrated by CD62P expression on platelets was not significantly different between rats with and without thrombocytosis (6.41 +/- 0.95 percent versus 4.51 +/- 0.55 percent, respectively; p = 0.089). As immature platelets were not increased (2.86 +/- 0.33 percent versus 1.99 +/- 0.32 percent, p = 0.074), it seems that the splenectomy-induced thrombocytosis is the result of redistribution of platelets instead of an increase in bone marrow production. There were no significant differences in the patency rates or perfusion units of femoral artery after arterial anastomosis between rats with and without thrombocytosis (90 percent and 95 percent, respectively; p = 0.561). In conclusion, this study demonstrates that microvascular anastomosis can be performed safely in patients with reactive thrombocytosis without platelet activation.

Is There an Association between Comorbidities and the Outcome of Microvascular Free Tissue Transfer?

“…Reactive thrombocytosis has been described before to not worsen prognosis significantly. 16 In this study, the outcome was significantly better in those patients with elevated platelet count on the day before surgery and significantly worse in those with lowered platelet count. Parameters like CRP and white blood cells mirroring ongoing infection and surgical trauma also influenced the outcome.…”

Thrombocytosis is associated with complications after microvascular surgery: An NSQIP data analysis

“…Our results indicated that there is a significant association with preoperative thrombocytosis and an increased risk for the need for reoperation, prolonged hospital stays, and blood transfusion. Thrombus formation at the anastomosis, which usually occurs within the first 24 hr after surgery (Mirzabeigi et al, ), is the most common reason for failure (Kuo et al, ; Kuo et al, ). This most frequently occurs at the venous anastomosis but can also occur at the arterial anastomoses (Cho et al, ; Herrera et al, ).…”

“…Essential to the success of the procedure is the maintenance of patency of both the arterial supply and the venous drainage of the transferred tissue. While the current success rate of the surgery is approximately 98% in a large‐volume center (Lin, Cabrera, Chew, & Kuo, ), the most common cause of failure of microvascular tissue transfer is thrombosis at the anastomotic site (Kuo et al, ; Kuo, Yang, Huang, Wei, & Jeng, ). Formation of these thromboses most commonly occurs within the first 24 hr of the operation (Mirzabeigi et al, ).…”

“…Previous groups have discussed the risk of hypercoagulable diseases on microvascular free flap success (Herrera et al, ). However, the risks of other hematologic disorders, thrombocytosis in particular, are not well described and the current literature is conflicting (Kuo et al, ; Kuo et al, ; Lin et al, ).…”

“…Thrombocytosis, defined as the condition of having a platelet count above 450,000 μ/L, can occur as a result of several physiologic and pathologic processes, which are generally divided into reactive thrombocytosis and primary thrombocytosis (Cho et al, ). By utilizing the NSQIP database, this project will provide information based on larger groups of subjects than previously studied (Cho et al, ; Kuo et al, ; Kuo et al, ; Lin et al, ). We hypothesized that patients with preoperative thrombocytosis would have increased complication rates and length of hospital stays after microvascular free tissue transfers.…”