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European Journal of Plastic Surgery

, Volume 37, Issue 5, pp 297–300 | Cite as

Flap reconstruction in two patients with rare blood coagulation disorders

  • Toshihiko Hayashi
  • Akira Saito
  • Hiroshi Furukawa
  • Akihiko Oyama
  • Emi Funayama
  • Yuhei Yamamoto
Case Report
  • 93 Downloads

Abstract

Coagulation disorders can be classified into two types: excessive bleeding and excessive clotting. Furthermore, the severity of the coagulation disorders can vary significantly among patients. We evaluated two relatively rare cases involving factor XIII subunit deficiency and antiphospholipid syndrome (APS) with concomitant systemic lupus erythematosus (SLE) in two patients undergoing flap reconstructions after tumor excision. In the patient with excessive bleeding as a result of a factor XIII subunit deficiency, flap necrosis occurred from a large subcutaneous hematoma that pressed on the perforator pedicle. Normal clotting function was restored during the surgery by administering a factor XIII preparation (Fibrogammin® P). The patient with excessive clotting as a result of APS and SLE suffered necrosis of the flaps after undergoing radial forearm free flap (RFFF) and pedicled pectoralis major musculocutaneous (PMMC) flap operations. With clotting factor deficiencies, there are patients in whom no evidence of a coagulation disorder exists preoperatively. It is important for surgeons to pay close attention to the potential for coagulation disorders patients and to consult with specialists promptly when indicated.

Level of Evidence: Level V, risk/prognostic study.

Keywords

Flap reconstruction Blood coagulation disorder Factor XIII Antiphospholipid syndrome 

Notes

Conflict of interest

None.

Ethical standards

This study has been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave their informed consent prior to their inclusion in the study.

References

  1. 1.
    Duckert F, Jung E, Shmerling DH (1960) A hitherto undescribed congenital haemorrhagic diathesis probably due to fibrin stabilizing factor deficiency. Thromb Diath Haemorrh 15:179–186Google Scholar
  2. 2.
    Karimi M, Bereczky Z, Cohan N, Muszbek L (2009) Factor XIII deficiency. Semin Thromb Hemost 35:426–438PubMedCrossRefGoogle Scholar
  3. 3.
    Warnecke IC, Kretschmer F, Bruner S, Frerichs O, Fansa H (2007) Hereditary thrombophilia in free microvascular flaps: a case report. Handchir Mikrochir Plast Chir 39:220–224PubMedCrossRefGoogle Scholar
  4. 4.
    Salgarello M, Cervelli D, Barone-Adesi L (2008) A massive arterial thrombosis of a free anterolateral thigh flap in a patient with antiphospholipid syndrome. Microsurgery 28:447–451PubMedCrossRefGoogle Scholar
  5. 5.
    Asai E, Okouchi M, Momiyama M et al (2010) Free flap failure in an anticardiolipin antibody-positive patient with neoplasma-a case report. Microsurgery 30:238–241PubMedGoogle Scholar
  6. 6.
    Dragu A, Bach AD, Leffler M, Unglaub F, Horch RE (2009) Acute and diffuse postoperative bleeding after free latissimus dorsi flap–Factor XIII deficiency: a case report and review of the literature. Med Sci Monit 15:CS1–CS4PubMedGoogle Scholar
  7. 7.
    Kanda A, Kaneko K, Obayashi O, Mogami A (2013) The massive bleeding after the operation of hip joint surgery with the acquired haemorrhagic coagulation factor XIII(13) deficiency: two case reports. Case Rep Orthop. doi: 10.1155/2013/473014 PubMedCentralPubMedGoogle Scholar
  8. 8.
    Plog U (2013) A 79-year-old patient with severe bleeding after colon surgery and normal global coagulation parameters. Int (Berl) 54:1510–1512CrossRefGoogle Scholar
  9. 9.
    Karges HE, Metzner HJ (1996) Therapeutic factor XIII preparations and perspective for recombinant factor XIII. Semin Thromb Hemost 22:427–436PubMedCrossRefGoogle Scholar
  10. 10.
    Lusher J, Pipe SW, Alexander S, Nugent D (2010) Prophylactic therapy with Fibrogammin P is associated with a decreased incidence of bleeding episodes: a retrospective study. Haemophilia 16:316–321PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Toshihiko Hayashi
    • 1
  • Akira Saito
    • 1
  • Hiroshi Furukawa
    • 1
  • Akihiko Oyama
    • 1
  • Emi Funayama
    • 1
  • Yuhei Yamamoto
    • 1
  1. 1.Department of Plastic and Reconstructive Surgery, Graduate School of MedicineHokkaido UniversitySapporoJapan

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