Complete free flap loss due to extensive hemodilution

Namdar, Thomas; Bartscher, Tanja; Stollwerck, Peter Leonard; Mailänder, P.; Lange, Thomas

doi:10.1002/micr.20736

Cited by 26 publications

(24 citation statements)

References 17 publications

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“…However, the study was limited by a very small sample size. Another retrospective study, by Namdar et al, found a significant association between saline infusion volumes and flap loss, as well as total infusion volume to body weight ratios and flap loss . Again, they were limited by a sample size of 48, with only four flap losses.…”

Section: Discussionmentioning

confidence: 97%

Anemia is not a predictor of free flap failure: A review of NSQIP data

et al. 2013

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Background Thrombosis is a common cause of flap failure in microvascular tissue transfer, which questions the effects of anemia on this outcome. This article seeks to contribute a large, multi‐institutional data analysis to this debate. Methods Free tissue transfer patients were identified in the National Surgical Quality Improvement database through a specified Current Procedural Terminology algorithm. Bivariate analysis compared anemic and nonanemic groups with respect to flap failure and other outcomes. Multivariable logistic regression was used to determine risk factors for flap failure. Results Of the 864 patients who met inclusion criteria, 244 were anemic and 620 were not. Bivariate analysis showed no significant difference between groups with respect to flap failure (3.28% vs. 4.03%, P = 0.0603). Multivariate regression analysis supported this (OR 95% CI = 0.371–1.912). Conclusions These findings, based on the largest sample in the literature, show anemia is neither a predictor of free tissue transfer failure nor is it protective. © 2013 Wiley Periodicals, Inc. Microsurgery 33:432–438, 2013.

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Section: Discussionmentioning

confidence: 97%

Anemia is not a predictor of free flap failure: A review of NSQIP data

et al. 2013

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“…24 In contrast, a study by Namdar et al found a significant association between saline infusion volumes and flap loss, as well as total infusion volume to body weight ratios and flap loss. 46 Again, they were limited by a sample size of 48, with only four flap losses. In a retrospective review of 354 breast free flaps, Zhong et al observed an increased rate of perioperative complications in patients with increased rates of fluid resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Transfusion of Packed Red Blood Cells in Microvascular Free Tissue Transfer Patients: Assessment of 30-Day Morbidity Using the NSQIP Dataset

Kim

Halen

Mlodinow

et al. 2013

J reconstr Microsurg

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Although often a life-saving therapeutic maneuver, there is minimal data available that details the effects of intraoperative packed red blood cell transfusion (IOT) after microvascular free tissue transfer. The National Surgical Quality Improvement Program database was queried to identify all patients who underwent microvascular free tissue transfer between 2006 and 2010. Multivariate logistic regression models were used to determine the association between intraoperative transfusion and outcomes. Upon bivariate and multivariate analyses, IOT was significantly associated with higher rates of overall complications (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.12-3.63), medical complications (OR, 3.35; 95% CI, 1.75-6.42), postoperative transfusion (OR, 6.02; 95% CI, 2.02-17.97), and reoperation (OR, 2.24; 95% CI, 1.24-4.04). IOT was not associated with either surgical complications or free flap loss. IOT significantly increases risk for adverse overall and medical complications. However, IOT was not associated with surgical complications or free flap loss. Transfusion practices in the operating room should be reevaluated to improve overall outcomes.

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“…These include employment of systemic medications such as Heparin (intravenously and PTT-controlled or as subcutaneous injections), HES, Albumine, and techniques of haemodilution using different concentrations of saline infusions. Especially the effect of haemodilution has been reported contradictory with groups describing a significant increase in flap loss [34][35][36][37][38][39]. As one of the more recent approaches, Sildenafil (Viagra V R ) has been shown to postoperatively increase the bloodflow in free LD transfers in one experimental animal study [40].…”

Section: Discussionmentioning

confidence: 99%

Markers of blood coagulation and fibrinolysis in patients with early and delayed microsurgical reconstructions in the lower extremities

Kloeters

Vasilic

Hupkens

et al. 2017

Journal of Plastic Surgery and Hand Surgery

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Background: In this study, markers of coagulation and fibrinolysis were assessed during early and delayed microsurgical reconstruction in patients with traumatic defects of their lower legs to analyse whether an imbalance of the hemostasis after trauma might predispose the development of vascular complications. Methods: The prospective study included 70 patients. In 35 patients, surgery was performed within 72 hours after injury. In 35 other patients, delayed free flap transfer was performed between 14-21 days after trauma. In each group, reconstruction was performed with a fasciocutaneous anterior-lateral thigh flap (ALT, n ¼ 18) or a myocutaneous flap (latissimus dorsi flap; n ¼ 17). Blood samples were collected preoperatively, intraoperatively, and 3,6,12,24,36, 48, 72, 96 and 120 hours after the operation. Analysed parameters included markers of coagulation such as prothrombin fragment 1 þ 2 (F1 þ 2), thrombin-antithrombin III-complex (TAT), and antithrombin, as well as fibrinolysis markers such as plasminogenactivator inhibitor-I (PAI-1), tissue-plasminogenactivator (t-PA), and plasminogen. Results: Preoperatively, levels of F1 þ 2, TAT, and PAI-1 were significantly higher in patients with delayed reconstruction (p < .05). Patients with later vascular complications in this group (n ¼ 5) presented a significant higher concentration of TAT, F1 þ 2, and PAI-1 (p < .05). Twelve and 24 hours after free flap surgery, patients with vascular complications presented significant elevated levels of these markers (p < .05). Conclusions: Patients with delayed free flap surgery after lower leg trauma present a hypercoagulable state in their blood due to activation of the coagulation system and hypofibrinolysis. Early reconstruction might minimise the risk of flap failure caused by hypercoagulability.

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Complete free flap loss due to extensive hemodilution

Abstract: We demonstrate the clinical relevance of extensive intraoperative hyperhydration, which can provoke a complete free flap loss.

Cited by 26 publications

References 17 publications

Anemia is not a predictor of free flap failure: A review of NSQIP data

Anemia is not a predictor of free flap failure: A review of NSQIP data

Intraoperative Transfusion of Packed Red Blood Cells in Microvascular Free Tissue Transfer Patients: Assessment of 30-Day Morbidity Using the NSQIP Dataset

Markers of blood coagulation and fibrinolysis in patients with early and delayed microsurgical reconstructions in the lower extremities

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