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J Reconstr Microsurg 2024; 40(01): 040-049
DOI: 10.1055/a-2056-1561
Original Article

Free Tissue Transfer to the Lower Extremity in the Setting of Thrombocytosis and the Role of Antiplatelet Therapy: A Propensity Score–Matched Analysis

Lauren E. Berger 
1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
2   Plastic and Reconstructive Surgery Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
,
Samuel S. Huffman 
1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
3   Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
,
John D. Bovill
3   Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
,
Daisy L. Spoer 
1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
3   Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
,
Stephanie Shin
3   Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
,
Brian N. Truong
3   Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
,
Nisha Gupta
3   Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
,
Christopher E. Attinger
1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Cameron M. Akbari
4   Department of Vascular Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Karen K. Evans
1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
› Author Affiliations Funding None.
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Abstract

Background Free tissue transfer (FTT) provides a versatile method to achieve successful lower limb salvage. Thrombocytosis in patients undergoing lower extremity (LE) FTT is associated with increased risk of complications. The aims of this study were to assess the feasibility of performing LE FTT in patients with preoperative thrombocytosis, and whether antiplatelet (AP) therapy on the day of surgery (DOS) affects outcomes.

Methods A retrospective review of thrombocytotic patients who underwent LE FTT between 2011 and 2022 was performed. Patients were stratified into groups based on the receipt of AP therapy on the DOS. Patients were propensity score matched for comorbidity burden and postoperative risk stratification. Outcomes of interest included perioperative transfusion requirements, postoperative flap-related complications, rates of flap success, limb salvage, and ambulatory status.

Results Of the 279 patients who underwent LE FTT, 65 (23.3%) were found to have preoperative thrombocytosis. Fifty-three patients remained following propensity score matching; of which, 32 (60.4%) received AP therapy on the DOS and 21 (39.6%) did not. Overall flap success rate was 96.2% (n = 51). The likelihoods of thrombosis and hematoma development were similar between cohorts (p = 0.949 and 0.574, respectively). Receipt of DOS AP therapy was associated an additional 2.77 units and 990.10 mL of transfused blood (p = 0.020 and 0.018, respectively). At a mean follow-up of 20.7 months, overall limb salvage and ambulatory rates were 81.1% (n = 43) and 79.2% (n = 42), respectively, with no differences between cohorts.

Conclusion Preoperative thrombocytosis is not an absolute contraindication to LE FTT. DOS AP therapy may be protective in comorbid patients with elevated platelet counts but must be weighed against possible short-term bleeding as suggested by significant increases in postoperative transfusion requirements.

Keywords

free tissue transfer - free flaps - limb salvage - thrombocytosis - antiplatelet chemoprophylaxis

Supplementary Material



Publication History

Received: 28 September 2022

Accepted: 28 February 2023

Accepted Manuscript online:
16 March 2023

Article published online:
26 April 2023

© 2023. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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