Thromboelastometry for Assessing Risks of Free Flap Thrombosis in Patients Undergoing Microvascular Surgery

Vanags, Indulis; Stepanovs, J.; Ozoliņa, Agnese; Mukāns, Maksims; Bjertnæs, Lars J.; Mamaja, Biruta

doi:10.3389/fmed.2020.00289

Cited by 12 publications

(17 citation statements)

References 54 publications

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“…2019 14 Turkey 77 patients undergoing free flap reconstruction There was no significant relationship between pre-operative and post-operative TEG and flap complications and loss Retrospective case series 4 Vanags et al. 2020 7 Latvia 103 consecutive adult patients with traumatic injuries undergoing free flap surgery In the late surgery group, thromboelastometry supports the detection of hypercoagulability and predicts free flap thrombosis risk Prospective cohort 3 …”

Section: Resultsmentioning

confidence: 99%

Thromboelastography in Microsurgical Reconstruction: A Systematic Review

2022

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Section: Resultsmentioning

confidence: 99%

Thromboelastography in Microsurgical Reconstruction: A Systematic Review

2022

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“…In the most recently published study, Vanags et al 29 also evaluated the predictive value of FPR derived from ROTEM for free flap thrombosis in the trauma population. One hundred three patients underwent free flap reconstruction for traumatic defects, most frequently of an extremity (94%).…”

Section: Resultsmentioning

confidence: 99%

Utility of Viscoelastic Tests to Predict Flap Thrombosis: A Systematic Review

Malapati

Hanwright

Tuffaha

2021

Plastic and Reconstructive Surgery - Global Open

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Background: Flap thrombosis is a rare but devastating complication in microsurgery. Preoperative identification of patients at increased risk for microvascular thrombosis remains challenging. Viscoelastic testing (VET) provides a comprehensive evaluation of the clotting process and can effectively identify hypercoagulability. However, the utility of VET in microvascular reconstruction remains unclear. Methods: A systematic review of the association between VET and pedicle thrombosis and free flap loss was performed in accordance with Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Identified studies were reviewed independently by two authors for pertinent data. Results: Six studies met inclusion criteria. Heterogenous study design and outcome reporting complicated direct comparisons and precluded a formal meta-analysis. Four studies found a statistically significant relationship between VET results and flap thrombosis or flap loss. The maximum clot strength and the fibrinogen-to-platelet ratio (FPR) were key viscoelastic parameters in these studies, both representing a measure of maximal clot strength. Specifically, an elevated FPR (>42%) generated a sensitivity and specificity for flap loss ranging from 57% to 75% and 60% to 82%, respectively. Notably, the negative predictive value for flap failure with a normal preoperative FPR was greater than 90% in all studies reporting a correlation. The remaining two studies reported no predictive value for VET with respect to flap failure or pedicle thrombosis. Conclusion: The results of this review suggest that VET, particularly parameters relating to clot strength, may help clinicians identify patients at risk for flap thrombosis. However, uncontrolled and heterogenous reporting limit definitive conclusions, and high-quality diagnostic studies are needed to better determine the clinical utility of viscoelastic testing for free flap patients.

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“…As reported previously (Vanags et al, 2020), although all patients in our study received standardised treatment, and received operations by experienced plastic surgeons who routinely perform microvascular flap surgery, we consider that technical surgical factors are one of most important limitations. We were also not able to avoid the multifactorial nature of a thrombotic event and the human factor in surgery and post-operative care.…”

Section: Discussionmentioning

confidence: 96%

“…Moreover, the analysed clinical outcome in our study was free flap thrombosis. The average incidence of free flap thrombosis varies between 8 and 10% (Vanags et al, 2020). In a recent study (Vanags et al, 2020), free flap thrombosis developed in 15.5% of microvascular flap surgery patients.…”

Section: Discussionmentioning

confidence: 98%

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Inherited Thrombophilias in Thrombosis Advancement in Microvascular Flap Surgery

Ozoliņa

Vanags

Drizlionoka

et al. 2021

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

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Microvascular flap surgery is a reliable method for reconstructive surgery. To avoid and foresee free flap thrombosis advancement after microvascular flap surgery, patient assessment, flawless surgical technique, and eligible perioperative care are pivotal. In this prospective observational study, we aimed to elucidate the most common inherited single nucleotide polymorphisms (SNPs) attributable to free flap thrombosis. A total of 152 patients undergoing microvascular flap surgery during the study period of 2016–2019 were analysed for five SNPs: rs6025 in Factor V Leiden (FVL) gene, rs1799963 in Factor II (FII) gene, rs2066865 in Fibrinogen Gamma Chain gene (FGG), rs2227589 in SERPINC 1 gene and rs1801133 in Methylene Tetrahydrofolate Reductase (MTHFR) gene. Activated protein C resistance (aPCR), prothrombin, antithrombin (AT), fibrinogen and homocysteine plasma levels were measured to determine association with the analysed SNPs and with free flap thrombosis advancement. Our preliminary results show that carriers of FVL mutation were associated with aPCR, as we observed significantly lower aPCR plasma levels in carriers of genotype C/T, as compared to C/C; p = 0.006 (CI 95%, 0.44 to 1.19). Additionally, mean fibrinogen plasma levels were higher in carriers of FGC gene rs2066865 genotype A/A (5.6 ± 1.81 g/l), as compared to G/A and G/G; p = 0.04 (CI 95%, 0.007 to 1.09); p = 0.004 (CI 95%, 0.48 to 2.49), respectively. The study group included 12 patients (7.9%) with free flap thrombosis. For one patient free flap thrombosis advancement might have been related to the rs6025T – FVL mutation with a PCR plasma level 1.21. Lower aPCR levels was associated with carriers of FVL rs6025 C/T and higher fibrinogen plasma levels with carriers of FGG rs2066865 A/A, suggesting that these genotypes might predict higher free flap thrombosis risk, but we found no significant association between analysed SNPs and free flap thrombosis advancement.

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Thromboelastometry for Assessing Risks of Free Flap Thrombosis in Patients Undergoing Microvascular Surgery

Cited by 12 publications

References 54 publications

Thromboelastography in Microsurgical Reconstruction: A Systematic Review

Thromboelastography in Microsurgical Reconstruction: A Systematic Review

Utility of Viscoelastic Tests to Predict Flap Thrombosis: A Systematic Review

Inherited Thrombophilias in Thrombosis Advancement in Microvascular Flap Surgery

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