Thromboprophylaxis in microsurgery

Anastomosis, Surgical/adverse effects/methods; Animals; Humans; Microcirculation; Microsurgery/adverse effects/methods; Surgical Flaps; Thrombosis/prevention & control; Vascular Surgical Procedures/adverse effects/methods

Abstract :

[en] Microsurgical free tissue transfer has become a gold standard in a wide range of clinical situations. Thrombosis at the anastomotic site is not only the most common cause of failure of microsurgical operations, but it is also one of the factors resulting in microcirculatory intravascular thrombosis in free flaps. All conditions of thrombus formation, defined by Virchow in 1856, are encountered in free flap surgery. This literature review concerns the problem of thromboprophylaxis in microsurgery. All citations published this last ten years (1996-2005) concerning this problem are noted. Data are confronted with other specialties, particularly vascular surgery, or with large retrospective studies. Protocol used in our institution is presented at the end of this lecture.

Disciplines :

Anesthesia & intensive care
Surgery

Author, co-author :

Lecoq, Jean-Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation

Senard, Marc ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation

Hartstein, Gary ; Centre Hospitalier Universitaire de Liège - CHU > Urgences - Anesthésie et réanimation

Lamy, Maurice ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques

Heymans, Olivier

Language :

English

Title :

Thromboprophylaxis in microsurgery

Publication date :

2006

Journal title :

Acta Chirurgica Belgica

ISSN :

1784-3421

eISSN :

2577-0160

Publisher :

Acta Medica Belgica, Bruxelles, Belgium

Volume :

106

Issue :

Pages :

158-64

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 25 March 2009

Statistics

Number of views

106 (3 by ULiège)

Number of downloads

0 (0 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

Bibliography

KHOURI R. K., COOLEY B. C., KUNSELMAN A. R., LANDIS J. R., YERAMIAN P., INGRAM D. et al. A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg, 1998, 102: 711-21.
SIGURDSSON G. H., THOMSON D. Anaesthesia and microvascular surgery: clinical practice and research. Eur J Anaesthesiol, 1995, 12: 101-22.
DESBOROUGH J. P. The stress response to trauma and surgery. Br J Anaesth, 2000, 85: 109-17.
CHIANG S., AZIZZADEH B., BUGA G., IGNARRO L., CALCATERRA T, BLACKWELL K. Local administration of nitric oxide donor significantly impacts microvascular thrombosis. Laryngoscope, 2003, 113: 406-9.
AZIZZADEH B., BUGA G. M., BERKE G. S., LARIAN B., IGNARRO L. J., BLACKWELL K. E. Inhibitors of nitric oxide promote microvascular thrombosis. Arch Facial Plast Surg, 2003, 5: 31-5.
BANIC A., KREJCI V., ERNI D., WHEATLEY A. M., SIGURDSSON G. H. Effects of sodium nitroprusside and phenylephrine on blood flow in free musculocutaneous flaps during general anesthesia. Anesthesiology, 1999, 90: 147-55.
LEE K. S., SUH J. D., HAN S. B., YOO J. C., LEE S. J., CHO S. J. The effect of aspirin and prostaglandin E(1) on the patency of microvascular anastomosis in the rats. Hand Surg, 2001, 6: 177-85.
GATELEY D. R., MCANULTY G. R., MARTIN D. L. Intravenous infusion of prostacyclin to prevent platelet thrombus during microvascular anastomoses. Br J Plast Surg, 1996, 49: 249-50.
RENAUD F., SUCCO E., ALESSI M. C., LEGRE R., JUHAN-VAGUE I. Iloprost and salvage of a free flap. Br J Plast Surg, 1996, 49: 245-8.
DE JONGE E., LEVI M. Effects of different plasma substitutes on blood coagulation: a comparative review. Crit Care Med, 2001, 29: 1261-7.
LANG K., BOLDT J., SUTTNER S., HAISCH G. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesth Analg, 2001, 93: 405-9.
ATCHABAHIAN A., MASQUELET A. C. Experimental prevention of free flap thrombosis. II: Normovolemic hemodilution for thrombosis prevention. Microsurgery, 1996, 17: 714-6.
FARINA J. A., JR, PICCINATO C. E., ROSSI M. A., MAZZER N., LLORACH-VELLUDO M. A. Effect of isovolemic hemodilution with 3% albumin on thrombus formation at venous microanastomosis in rats. Microsurgery, 2002, 22: 152-7.
CONRAD M. H., ADAMS W. P., Jr. Pharmacologic optimization of microsurgery in the new millennium. Plast Reconstr Surg, 2001, 108: 2088-96.
KROLL S. S., MILLER M. J., REECE G. P., BALDWIN B. J., ROBB G. L., BENGTSON B. P. et al. Anticoagulants and hematomas in free flap surgery. Plast Reconstr Surg, 1995, 96: 643-7.
HAHNENKAMP K., THEILMEIER G., VAN AKEN H. K., HOENEMANN C. W. The effects of local anesthetics on perioperative coagulation, inflammation, and microcirculation. Anesth Analg, 2002, 94: 1441-7.
SCOTT G. R., ROTHKOPF D. M., WALTON R. L. Efficacy of epidural anesthesia in free flaps to the lower extremity. Plast Reconstr Surg, 1993, 91: 673-7.
ERNI D., BANIC A., SIGNER C., SIGURDSSON G. H. Effects of epidural anaesthesia on microcirculatory blood flow in free flaps in patients under general anaesthesia. Eur J Anaesthesiol, 1999, 16: 692-8.
CHIEN W., VARVARES M. A., HADLOCK T, CHENEY M., DESCHLER D. G. Effects of aspirin and low-dose heparin in head and neck reconstruction using microvascular free flaps. Laryngoscope, 2005, 115: 973-6.
PETER F. W., FRANKEN R. J., WANG W. Z., ANDERSON G. L., SCHUSCHKE D. A., O'SHAUGHNESSY M. M. et al. Effect of low dose aspirin on thrombus formation at arterial and venous microanastomoses and on the tissue microcirculation. Plast Reconstr Surg, 1997, 99: 1112-21.
CHINO S., THOMA A., MONKMAN S., KELTON J. G. Inhibition of microsurgical thrombosis by the platelet glycoprotein IIb/IIIa antagonist SR121566A. Plast Reconstr Surg, 2003, 112: 177-85.
NAYAK V. K., DESCHLER D. G. Clopidogrel use for reducing the rate of thrombosis in a rat model of microarterial anastomosis. Arch Otolaryngol Head Neck Surg, 2005, 131: 800-3.
SHUFFLEBARGER J. V., DOYLE J., ROTH T, MAGUIRE K., ROTHKOPF D. M. The effect of ketorolac on microvascular thrombosis in an experimental rabbit model. Plast Reconstr Surg, 1996, 98: 140-5.
LI X., COOLEY B. C., FOWLER J. D., GOULD J. S. Intravascular heparin protects muscle flaps from ischemia/reperfusion injury. Microsurgery, 1995, 16: 90-3.
MIYAWAKI T., JACKSON I. T., ELMAZAR H., BIER U. C., BARAKAT K., ANDRUS L. et al. The effect of low-molecular-weight heparin in the survival of a rabbit congested skin flap. Plast Reconstr Surg, 2002, 109: 1994-9.
MALM K., DAHLBACK B., ARNLJOTS B. Low-molecular-weight heparin (dalteparin) effectively prevents thrombosis in a rat model of deep arterial injury. Plast Reconstr Surg, 2003, 111: 1659-66.
RITTER E. F., CRONAN J. C., RUDNER A. M., SERAFIN D., KLITZMAN B. Improved microsurgical anastomotic patency with low molecular weight heparin. J Reconstr Microsurg, 1998, 14: 331-6.
HUDSON D. A., ENGELBRECHT G., DUMINY F. J. Another method to prevent venous thrombosis in microsurgery: an in situ venous catheter. Plast Reconstr Surg, 2000, 105: 999-1003.
ROESKEN F., VOLLMAR B., RUCKER M., SEIFFGE D., MENGER M. D. In vivo analysis of antithrombotic effectiveness of recombinant hirudin on microvascular thrombus formation and recanalization. J Vasc Surg, 1998, 28: 498-505.
BREUER M., SCHUTZ A., GANSERA B., EICHINGER W., WEINGARTNER J., KEMKES B. Intraoperative local fibrinolysis as emergency therapy after early coronary artery bypass thrombosis. Eur J Cardiothorac Surg, 1999, 15: 266-70.
LYKOUDIS E. G., CONTODIMOS G. B., TSOUTSOS D. A., FRANGIA K. B., PAPALOIS A. E., STAMATOPOULOS C. N. et al. Microsurgical repair after crush-avulsion injury of the femoral vein in rats: prevention of microvascular thrombosis with recombinant human tissue-type plasminogen activator (rt-PA). Microsurgery, 2001, 21: 357-61.
KHOURI R. K., SHERMAN R., BUNCKE H. J., JR, FELLER A. M., HOVIUS S., BENES C. O. et al. A phase II trial of intraluminal irrigation with recombinant human tissue factor pathway inhibitor to prevent thrombosis in free flap surgery. Plast Reconstr Surg, 2001, 107: 408-15.
SORENSEN H. B., KRISTENSEN A. T., RAVN H. B., FUGLSANG J., HJORTDAL V. E. Local application of FFR-rFVIIa reduces thrombus formation at arterial anastomosis in rats. Microsurgery, 1999, 19: 369-73.
ROHRICH R. J., HANDREN J., KERSH R., HERGRUETER C. A., MAY J. W., Jr. Prevention of microvascular thrombosis with short-term infusion of human tissue-type plasminogen activator. Plast Reconstr Surg, 1996, 98: 118-28.