Successful penile reconstruction following prior arteriovenous loop thrombosis due to undiagnosed protein-S deficiency and exogenous testosterone

Abstract

Flap failure from microvascular thrombotic occlusion is a rare but significant cause for unsuccessful reconstructive surgery. We encountered thrombosis of arteriovenous loop in a patient undergoing phallus reconstruction. Further investigations revealed underlying previously asymptomatic hypercoagulable state due to protein-S deficiency in addition to long-term exogenous testosterone administration. Role of thrombophilia testing, thrombogenic potential of testosterone and the need for therapeutic perioperative anti-coagulation in such situations are described here.

Thromboembolism Peaking 3 Months after Starting Testosterone Therapy: Testosterone–Thrombophilia Interactions

“…Beyond interacting with familial and acquired thrombophilia,17–20 22 23 25 27 60 61 TT is associated with prothrombotic changes including hypertension,62 elevated hemoglobin and hematocrit,63 low high-density lipoprotein cholesterol,63 platelet aggregation,64 and transient (∼4 months) hyperviscosity 65. TT increases circulating estrogens66 that subsequently play a role in thrombotic events 22.…”

Scalp replantation in a cervical spine injury patient: Lessons learnt

“…[ 15 ] We used low-molecular-weight heparin as post-operative anticoagulation as routine, in case of thrombogenic individuals, we use unfractionated heparin with close monitoring of international normalised ratio. [ 16 ] The occipital area necrosis is significant problem and multiple reasons have been discussed, most authors are of the opinion that it is the distal most part and least vascular or increased risk of venous congestion. [ 9 10 12 13 14 ] The other obvious reason is pressure necrosis due to immobilisation.…”