Abstract
Thrombosis in the free flap patient poses potentially the most significant risk factor for either partial or total flap failure. While prevention of thromboembolic complications can be achieved through careful vessel handling and the use of adjunctive pharmacological anti-coagulants, other risk factors including coagulopathic disorders are more difficult to control for. Of these, hereditary anti-thrombin III deficiency is well established to confer the highest risk for thromboembolic events among the documented hereditary thrombophilias. We present the first reported case of bilateral free flap breast reconstruction in a patient with a known history of anti-thrombin III deficiency. We discuss our approach to this case, including a suggested guideline for the management of the free flap patient with anti-thrombin III deficiency.
Level of evidence: Level V, therapeutic study.
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References
Cohn DM, Roshani S, Middeldorp S (2007) Thrombophilia and venous thromboembolism: implications for testing. Semin Thromb Hemost 33(6):573–581
Novakovic D et al (2009) Salvage of failed free flaps used in head and neck reconstruction. Head Neck Oncol 1:33
Wang TY, Serletti JM, Cuker A, McGrath J, Low DW, Kovach SJ, Wu LC (2012) Free tissue transfer in the hypercoagulable patient: a review of 58 flaps. Plast Reconstr Surg 129(2):443–453
Ltd, CBAP Product information - Thrombotrol®-VF. 2014; Available from: https://www.cslbehring.com.au/-/media/cslb-australia/documents/aus-pis-and-cmis/thrombotrolvf-au-pi-900.pdf?la=en-us&hash=6F8CCAA910243FD13D0B97DF4E2DE072E9D723F2
Camara O, Herrmann J, Egbe A, Koch I, Gajda M, Runnebaum IB (2009) Venous coupler for free-flap anastomosis. Anticancer Res 29(7):2827–2830
Kroll SS, Schusterman MA, Reece GP, Miller MJ, Evans GR, Robb GL, Baldwin BJ (1996) Timing of pedicle thrombosis and flap loss after free-tissue transfer. Plast Reconstr Surg 98(7):1230–1233
Kitchens CS (1985) Concept of hypercoagulability: a review of its development, clinical application, and recent progress. Semin Thromb Hemost 11(3):293–315
Wang TY et al (2012) A review of 32 free flaps in patients with collagen vascular disorders. Plast Reconstr Surg 129(3):421e–427e
Patnaik MM, Moll S (2008) Inherited antithrombin deficiency: a review. Haemophilia 14(6):1229–1239
Buller HR, ten Cate JW (1989) Acquired antithrombin III deficiency: laboratory diagnosis, incidence, clinical implications, and treatment with antithrombin III concentrate. Am J Med 87(3B):44S–48S
Sanson BJ, Simioni P, Tormene D, Moia M, Friederich PW, Huisman MV, Prandoni P, Bura A, Rejto L, Wells P, Mannucci PM, Girolami A, Büller HR, Prins MH (1999) The incidence of venous thromboembolism in asymptomatic carriers of a deficiency of antithrombin, protein C, or protein S: a prospective cohort study. Blood 94(11):3702–3706
Finazzi G, Caccia R, Barbui T (1987) Different prevalence of thromboembolism in the subtypes of congenital antithrombin III deficiency: review of 404 cases. Thromb Haemost 58(4):1094
Friedman T, O'Brien Coon D, Michaels VJ, Bontempo F, Young VL, Clavijo JA, Rubin JP (2010) Hereditary coagulopathies: practical diagnosis and management for the plastic surgeon. Plast Reconstr Surg 125(5):1544–1552
Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossetti G, Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) Working Party (2009) Recommendations for the use of antithrombin concentrates and prothrombin complex concentrates. Blood Transfus 7(4):325–334
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Nicholas Tang and Dean Trotter declare that they have no conflict of interest.
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Tang, N., Trotter, D. Anti-thrombin III deficiency in free flap transfer: a case report. Eur J Plast Surg 44, 147–150 (2021). https://doi.org/10.1007/s00238-020-01652-w
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DOI: https://doi.org/10.1007/s00238-020-01652-w