Microsurgery in the Hypercoagulable Patient: Review of the Literature

Fernando Antonio Herrera; Charles K. Lee; Gil Kryger; Jason Roostaeian; Bauback Safa; Robert F. Lohman; Lawrence J. Gottlieb; Robert L. Walton

doi:10.1055/s-0032-1311687

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2012; 28(05): 305-312
DOI: 10.1055/s-0032-1311687

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Microsurgery in the Hypercoagulable Patient: Review of the Literature

Fernando Antonio Herrera

¹The Buncke Clinic and Division of Microsurgery, California Pacific Medical Center, San Francisco, California

³Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California

,

Charles K. Lee

¹The Buncke Clinic and Division of Microsurgery, California Pacific Medical Center, San Francisco, California

²Division of Plastic and Reconstructive Surgery, University of California, San Francisco, California

,

Gil Kryger

⁴Kryger Institute of Plastic Surgery, Thousand Oaks, California

,

Jason Roostaeian

³Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California

,

Bauback Safa

¹The Buncke Clinic and Division of Microsurgery, California Pacific Medical Center, San Francisco, California

,

Robert F. Lohman

⁵ Division of Plastic and Reconstructive Surgery, The University of Chicago, Chicago, Illinois

,

Lawrence J. Gottlieb

⁵ Division of Plastic and Reconstructive Surgery, The University of Chicago, Chicago, Illinois

,

Robert L. Walton

⁵ Division of Plastic and Reconstructive Surgery, The University of Chicago, Chicago, Illinois

› Author Affiliations

Abstract

Improved techniques in microvascular surgery over the last several decades have led to the increased use of free tissue transfers as a mode of reconstructing difficult problems with a high success rate. However, undiagnosed thrombophilias have been associated with microsurgery free flap failures. We present a case of successful free tissue transfer in a patient with lupus anticoagulant and review the literature.

Keywords

thrombophilia - free flap salvage - blood vessel thrombosis - hypercoagulable states - free flap failure - free tissue transfer

Full Text

References

References
1 Kroll SS, Schusterman MA, Reece GP , et al. Timing of pedicle thrombosis and flap loss after free-tissue transfer. Plast Reconstr Surg 1996; 98: 1230-1233
2 Khouri RK, Cooley BC, Kunselman AR , et al. A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg 1998; 102: 711-721
3 Bui DT, Cordeiro PG, Hu QY, Disa JJ, Pusic A, Mehrara BJ. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg 2007; 119: 2092-2100
4 Davison SP, Kessler CM, Al-Attar A. Microvascular free flap failure caused by unrecognized hypercoagulability. Plast Reconstr Surg 2009; 124: 490-495
5 Uppal RS, Stillaert FB, Hamdi M. Antiphospholipid syndrome—a rare cause of free flap thrombosis in perforator flap breast reconstruction. J Plast Reconstr Aesthet Surg 2008; 61: 347-348
6 Davis MR, Shell IV DH, Marques M, Long JN. Free flap failure secondary to dual thrombophilia. Microsurgery 2009; 29: 62-65
7 Salgarello M, Cervelli D, Barone-Adesi L. A massive arterial thrombosis of a free anterolateral thigh flap in a patient with antiphospholipid syndrome. Microsurgery 2008; 28: 447-451
8 Labow BI, Greene AK, Upton J. Homocystinuria: an unrecognized cause of microvascular failure. Plast Reconstr Surg 2007; 120: 6e-12e
9 Nicoletti G, Gamba G, Scevola S, Faga A. The congenital deficit of protein S as a new prognostic factor in microsurgery. Plast Reconstr Surg 2005; 116: 1837-1838
10 Höijer P, Olsson E. Elevated coagulation factor VIII, postoperative thrombosis and flap failure in late breast reconstruction with a free TRAM flap: a case report. J Plast Reconstr Aesthet Surg 2006; 59: 102-104
11 Shaw RJ, Rogers SN. Venous microvascular anastomotic failure due to prothrombin gene mutation. Plast Reconstr Surg 2005; 115: 1451-1452
12 Ayala C, Blackwell KE. Protein C deficiency in microvascular head and neck reconstruction. Laryngoscope 1999; 109 (2 Pt 1) 259-265
13 Rand JH, Senzel L. Antiphospholipid antibodies and the antiphospholipid syndrome. In: Colman RW, Marder VJ, Clowes AW. et al, eds. Hemostasis and Thrombosis. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006: 1621-1636
14 Cohn DM, Roshani S, Middeldorp S. Thrombophilia and venous thromboembolism: implications for testing. Semin Thromb Hemost 2007; 33: 573-581
15 Nachman RL, Silverstein R. Hypercoagulable states. Ann Intern Med 1993; 119: 819-827
16 Villacorta J, Guidon C, Kerbaul F, Mesana T. An intraoperative coronary artery bypass graft thrombosis in a patient with protein S deficiency. J Cardiothorac Vasc Anesth 2001; 15: 805-806
17 Hidalgo DA, Disa JJ, Cordeiro PG, Hu QY. A review of 716 consecutive free flaps for oncologic surgical defects: refinement in donor-site selection and technique. Plast Reconstr Surg 1998; 102: 722-732 ; discussion 733–734
18 Petri M. Pathogenesis and treatment of the antiphospholipid antibody syndrome. Med Clin North Am 1997; 81: 151-177
19 Koster T, Blann AD, Briët E, Vandenbroucke JP, Rosendaal FR. Role of clotting factor VIII in effect of von Willebrand factor on occurrence of deep-vein thrombosis. Lancet 1995; 345: 152-155
20 Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med 2002; 346: 752-763
21 Robertson B, Greaves M. Antiphospholipid syndrome: an evolving story. Blood Rev 2006; 20: 201-212
22 Ortel TL. Thrombosis and the antiphospholipid syndrome. Hematology (Am Soc Hematol Educ Program) 2005; 462-468
23 Hughes GR. Thrombosis, abortion, cerebral disease, and the lupus anticoagulant. Br Med J (Clin Res Ed) 1983; 287: 1088-1089
24 Ware Branch D, Eller AG. Antiphospholipid syndrome and thrombosis. Clin Obstet Gynecol 2006; 49: 861-874
25 Urbanus RT, Siegerink B, Roest M, Rosendaal FR, de Groot PG, Algra A. Antiphospholipid antibodies and risk of myocardial infarction and ischaemic stroke in young women in the RATIO study: a case-control study. Lancet Neurol 2009; 8: 998-1005
26 Gezer S. Antiphospholipid syndrome. Dis Mon 2003; 49: 696-741
27 Galli M, Luciani D, Bertolini G, Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood 2003; 101: 1827-1832
28 Miyakis S, Lockshin MD, Atsumi T , et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295-306
29 Erkan D, Leibowitz E, Berman J, Lockshin MD. Perioperative medical management of antiphospholipid syndrome: hospital for special surgery experience, review of literature, and recommendations. J Rheumatol 2002; 29: 843-849
30 Warkentin TE, Levine MN, Hirsh J , et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med 1995; 332: 1330-1335
31 Warkentin TE. Heparin-induced thrombocytopenia. Hematol Oncol Clin North Am 2007; 21: 589-607 , v
32 McCleave MJ. Free flap failure caused by heparin-induced thrombocytopenia. Microsurgery 2010; 30: 251-252
33 Tremblay DM, Harris PG, Gagnon AR, Cordoba C, Brutus JP, Nikolis A. Heparin-induced thrombocytopenia syndrome as a cause of flap failure: a report of two cases. J Plast Reconstr Aesthet Surg 2008; 61: 78-83
34 Schleich AR, Oswald TM, Lineaweaver WC. Complete salvage of impending free flap failure in heparin induced thrombocytopenia by emergent institution of therapy with argatroban. J Plast Reconstr Aesthet Surg 2008; 61: 1263-1264
35 Busch KH, Knobloch K, Vogt PM. Evidence for a locally limited form of heparin-induced thrombocytopenia in plastic reconstructive surgery?. Plast Reconstr Surg 2009; 124: 277e-278e
36 Assmann A, Boeken U, Feindt P, Schurr P, Akhyari P, Lichtenberg A. Heparin-induced thrombocytopenia type II after cardiac surgery: predictors and outcome. Thorac Cardiovasc Surg 2010; 58: 463-467
37 Friedman T, O'Brien Coon D, Michaels V J , et al. Hereditary coagulopathies: practical diagnosis and management for the plastic surgeon. Plast Reconstr Surg 2010; 125: 1544-1552
38 U.S. Department of Health and Human Services. Available at: http://www.surgeongeneral.gov . Accessed August 1, 2011
39 O'Brien SH, Smith KJ. Using thrombophilia testing to determine anticoagulation duration in pediatric thrombosis is not cost-effective. J Pediatr 2009; 155: 100-104
40 Wu O, Greer IA. Is screening for thrombophilia cost-effective?. Curr Opin Hematol 2007; 14: 500-503
41 Baumeister S, Follmar KE, Zenn MR, Erdmann D, Levin LS. Strategy for reoperative free flaps after failure of a first flap. Plast Reconstr Surg 2008; 122: 962-971
42 Khouri RK. Avoiding free flap failure. Clin Plast Surg 1992; 19: 773-781