Thromboelastometry: A contribution to perioperative free-flap management

Wikner, Johannes; Beck‐Broichsitter, Benedicta; S, Schlesinger; Schön, Gerhard; Heiland, Max; Assaf, Alexandre T; Rashad, Ashkan; Riecke, Björn; Heckel, Kai

doi:10.1016/j.jcms.2015.05.016

Cited by 16 publications

(21 citation statements)

References 35 publications

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“…Among the factors that may cause flap complications and flap loss are the coagulation problems seen in patients and the use of anticoagulants (1,18). Venous obstruction was found to be responsible from 8 of 9 flap losses and from 16 of 20 flap re-operations in 198 breast reconstruction cases (17).…”

Section: Discussionmentioning

confidence: 99%

“…In 4640 flap cases performed after head and neck surgery, the main cause of complication and failure was found to be venous thrombosis in the recipient region, and a large number of cases had a history of malignancy (14). Zhou In free flap surgery, it is very important to detect and timely treat patients with risk factors in the preoperative or early postoperative period (1,18). Prediction of the thrombotic events by conventional coagulation tests or by viscoelastic methods, such as TEG and ROTEM, may improve the flap success.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Coagulation Status and Co-Morbidity on Flap Success and Complications in Patients with Reconstructed Free Flap

Ekin¹,

Günüşen²,

Özdemır³

et al. 2019

Turk J Anaesthesiol Reanim

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Objective: Free flap surgeries constitute the basis of reconstruction surgery in patients with major defects. Prediction of complications that cause flap loss in such patients is important in terms of reducing the length of hospital stay and expenses. We aimed to retrospectively investigate the effect of co-morbidities and the coagulation status on flap loss and complications in patients with reconstructed free flap. Methods: Demographic data, smoking, alcohol habits, co-morbidities, coagulation tests and thromboelastogram results from preoperative, intraoperative and postoperative anaesthesia and surgical records of patients undergoing free flap surgeries between January 2015 and June 2017 were retrospectively screened. Results: Flap success rate was found to be 96.1% in total 77 patients with free flap. Coagulation related complication rate, such as thrombosis, haematoma and partial necrosis, were 22.1%. There was a significant relationship between age, chronic obstructive pulmonary disease and hypercholesterolaemia and flap loss (p=0.006, p=0.025 ve p=0.025, respectively). Flap complications were more frequent in patients with chronic obstructive pulmonary disease and hypertension. Laboratory test results revealed no statistical correlation between flap complications and flap loss with preoperative and postoperative TEG. Conclusion: Advanced age, co-morbidities such as hypertension and chronic obstructive pulmonary disease are associated with complications and flap loss in free flap surgery. However, there were no clinically significant association of complications and flap loss with laboratory tests showing coagulation. We believe that standardised protocols should be established in terms of preparation, intraoperative management and postoperative follow-ups because the time between taking the coagulation tests and postoperative anticoagulant administration should be standardised in such surgeries.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of Coagulation Status and Co-Morbidity on Flap Success and Complications in Patients with Reconstructed Free Flap

Ekin¹,

Günüşen²,

Özdemır³

et al. 2019

Turk J Anaesthesiol Reanim

View full text Add to dashboard Cite

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“…22 Optimization of the perioperative management with individually based anticoagulative protocols requires further progress. Real-time monitoring of the hemostasis via thromboelastometry 23 and intra-arterial thrombolysis in case of thrombotic events 24 could be additional tools in the future. However, there was no statistical correlation between the thrombosis rates of arterial or venous anastomoses and the extent of anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Outcome Analysis of End-to-End and End-to-Side Anastomoses in 131 Patients Undergoing Microsurgical Free Flap Reconstruction of the Lower Extremity

Könneker

Broelsch

Kuhbier

et al. 2016

J Reconstr Microsurg Open

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Background End-to-end and end-to-side anastomoses remain the most common techniques in microsurgical free flap reconstruction. Still, there is an ongoing effort to optimize established techniques and develop novel techniques. Numerous comparative studies have investigated flow dynamics and patency rates of microvascular anastomoses and their impact on flap survival. In contrast, few studies have investigated whether the type of anastomosis influences the outcome of microvascular free flap reconstruction of a lower extremity. Patients and Methods Retrospectively, we investigated the outcome of 131 consecutive free flaps for lower extremity reconstruction related to the anastomotic technique. Results No statistical significance between arterial or venous anastomoses were found regarding the anastomotic techniques (p = 0.5470). However, evaluated separately by vessel type, a trend toward statistical significance for anastomotic technique was observed in the arterial (p = 0.0690) and venous (p = 0.1700) vessels. No thromboses were found in arterial end-to-end anastomoses and venous end-to-side anastomoses. More venous (n = 18) than arterial thromboses (n = 9) occurred in primary anastomoses undergoing microsurgical free flap reconstruction (p = 0.0098). Flap survival rate was 97.37% in the end-to-end arterial group versus 86.36% in the end-to-side group. No thromboses were found in five arterial anastomoses using T-patch technique. Conclusion For lower extremities, there is a connate higher risk for venous thrombosis in anastomotic regions compared with arterial thrombosis. We observed divergent rates for thromboses between end-to-end and end-to-side anastomoses.However, if thrombotic events are explained by anastomotic technique and vessel type, the latter carries more importance.

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“…Approximately 5-10% of the population is estimated to have a hypercoagulable condition, which frequently is unrecognised or not detectable by routine tests (Rosendaal, 1999;Kitchens, 2008). Some authors have assessed the use of rotational thromboelastometry (RTE) for hypercoagulability detection in free flap surgery (Kolbenschlag et al, 2014;Wikner et al, 2015) (Fig. 2).…”

Section: Preoperative Patient-dependent Risk Fac-torsmentioning

confidence: 99%

Factors Affecting the Risk of Free Flap Failure in Microvascular Surgery

Stepanovs

Ozoliņa

Rovīte

et al. 2016

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Microvascular free flap surgery, has become an important part of reconstructive surgery during the last decades, as it allows closure of various tissue defects and recovery of organs function. Despite surgical progress resulting in high rates of transferred tissue survival, the risk of pedicle vessels thrombosis still remains a significant problem. A total of 108 articles from Pubmed and Science Direct databases published in 2005–2015 were analysed. This review of the literature assessed the influence of patient-dependent risk factors and different perioperative management strategies on development of microvascular free flap thrombosis. Sufficient evidence for risk associated with hypercoagulation, advanced age and certain comorbidities was identified. Presently, rotational thromboelastometry allows early hypercoagulability detection, significantly changing further patient management. Identification of flap thrombosis promoting surgery-related aspects is also essential in preoperative settings. Choice of anaesthesia and postoperative analgesia, administration of different types and amounts of fluids, blood products and vasoactive agents, temperature control are no less important in perioperative anaesthesiological management. More attention should be focused on timely preoperative evaluation of patient-dependent risk factors, which can influence anaesthesiological and surgical tactics during and after microvascular free flap surgery. Perioperative anaesthesiological management strategy continues to be controversial and therefore it should be performed based on thrombotic risk assessment and patient individual needs, thus improving flap survival rates and surgical outcome.

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Thromboelastometry: A contribution to perioperative free-flap management

Cited by 16 publications

References 35 publications

Effect of Coagulation Status and Co-Morbidity on Flap Success and Complications in Patients with Reconstructed Free Flap

Effect of Coagulation Status and Co-Morbidity on Flap Success and Complications in Patients with Reconstructed Free Flap

Outcome Analysis of End-to-End and End-to-Side Anastomoses in 131 Patients Undergoing Microsurgical Free Flap Reconstruction of the Lower Extremity

Factors Affecting the Risk of Free Flap Failure in Microvascular Surgery

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