Free flap thrombosis in patients with hypercoagulability: A systematic review

다국어 초록 (Multilingual Abstract)

Background Even with satisfactory anastomosis technique and adequate experience of thesurgeon, flap loss due to thrombosis can still occur due to the patient’s underlying condition.
Patients with hypercoagulability due to etiologies such as malignancy, hereditary conditions,and acquired thrombophilia are among those who could benefit from free flap procedures.
This review aimed to evaluate the risk of free flap thrombosis in patients with hypercoagulabilityand to identify the most effective thromboprophylaxis regimen.
Methods This review was conducted in accordance with the Preferred Reporting Items forSystematic Reviews and Meta-Analyses guideline. The PubMed, Embase, and Cochrane Librarydatabases were explored. Types of free flaps, types of hypercoagulable states, thrombosis preventionprotocols, thrombosis complication rates, and flap vitality outcomes were reviewed.
Samples from the included studies were pooled to calculate the relative risk of free flapthrombosis complications in patients with hypercoagulability compared to those without hypercoagulability.
Results In total, 885 articles underwent title, abstract, and full-text screening. Six articlesmet the inclusion criteria. The etiologies of hypercoagulability varied. The overall incidence ofthrombosis and flap loss in hypercoagulable patients was 13% and 10.3%, respectively. Thethrombosis risk was two times higher in hypercoagulable patients (P=0.074) than in controls.
Thromboprophylaxis regimens were variable. Heparin was the most commonly used regimen.
Conclusions Hypercoagulability did not significantly increase the risk of free flap thrombosis.
The most effective thromboprophylaxis regimen could not be determined due to variationin the regimens. Further well-designed studies should be conducted to confirm this finding.

참고문헌 (Reference)

1 Buncke HJ Jr, "Total ear reimplantation in the rabbit utilizing microminiature vascular anastomoses" 19 : 15-22, 1966

2 Moll S, "Thrombophilia : clinical-practical aspects" 39 : 367-378, 2015

3 Baumeister S, "Strategy for reoperative free flaps after failure of a first flap" 122 : 962-971, 2008

4 National Heart, Lung, and Blood Institute, "Quality Assessment Tool for Case Series Studies" National Institutes of Health

5 Nelson JA, "Prevention of thrombosis in hypercoagulable patients undergoing microsurgery : a novel anticoagulation protocol" 70 : 307-312, 2017

6 Moher D, "Preferred reporting items for systematic reviews and meta-analyses : the PRISMA statement" 8 : 336-341, 2010

7 Handschel J, "Parameters predicting complications in flap surgery" 115 : 589-594, 2013

8 Arnljots B, "No correlation between activated protein C resistance and free flap failures in 100 consecutive patients" 101 : 1850-1853, 1998

9 Davison SP, "Microvascular free flap failure caused by unrecognized hypercoagulability" 124 : 490-495, 2009

10 Herrera FA, "Microsurgery in the hypercoagulable patient : review of the literature" 28 : 305-312, 2012

11 Pannucci CJ, "Microsurgery and the hypercoagulable state : a hematologist’s perspective" 136 : 545e-552e, 2015

12 Senchenkov A, "Management of perioperative microvascular thrombotic complications : the use of multiagent anticoagulation algorithm in 395 consecutive free flaps" 68 : 1293-1303, 2015

13 DeFazio MV, "Lower extremity flap salvage in thrombophilic patients : managing expectations in the setting of microvascular thrombosis" 32 : 431-444, 2016

14 Sezgin B, "Hypercoagulability in microvascular breast reconstruction : an algorithmic approach for an underestimated situation" 28 : 515-520, 2012

15 Srikanthan K, "Free-flap failure in thrombophilia : case report and systematic review of the literature" 71 : 675-681, 2013

16 Wang TY, "Free tissue transfer in the hypercoagulable patient : a review of 58 flaps" 129 : 443-453, 2012

17 Endara M, "Free flap breast reconstruction in the hypercoagulable patient with a concomitant bleeding diathesis" 132 : 180e-181e, 2013

18 Bowman KG, "Flap complications and thrombophilia : an evidence-based model and cost analysis for preoperative screening" 11 : e32-, 2011

19 Khansa I, "Factor V Leiden associated with flap loss in microsurgical breast reconstruction" 31 : 409-412, 2011

20 Motakef S, "Emerging paradigms in perioperative management for microsurgical free tissue transfer : review of the literature and evidence-based guidelines" 135 : 290-299, 2015

21 Pan XL, "Effect of heparin on prevention of flap loss in microsurgical free flap transfer : a meta-analysis" 9 : e95111-, 2014

22 Davison SP, "Anatomy of free flap failures : dissection of a series" 03 : 89-95, 2013

23 Olsson E, "Activation of coagulation and fibrinolysis during reconstructive microsurgery in patients with cancer" 21 : 208-213, 2001

24 Wang TY, "A review of 32 free flaps in patients with collagen vascular disorders" 129 : 421e-427e, 2012

25 Khouri RK, "A prospective study of microvascular free-flap surgery and outcome" 102 : 711-721, 1998