Increased Incidence of Symptomatic Deep Venous Thrombosis Following Lower Extremity Flap Harvest for Abdominal and Perineal Reconstruction: A Case for Extended Surveillance
Justin M. Broyles, MD, Gurjot S. Walia, BS, Ricardo Bello, MD, MPH, Rachel A. Pedriera, BA, Hannah M. Carl, BS, WP Andrew Lee, MD, MPH, Justin M. Sacks, MD, MBA.
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Background: Postsurgical venous thromboembolism (VTE) remains a leading cause of hospital morbidity and data to support VTE prophylaxis guidelines in lower extremity flap surgery are currently lacking. The purpose of this study was to identify the incidence of symptomatic VTE in patients undergoing harvest of lower extremity flaps who received standard chemoprophylaxis while hospitalized to identify factors which could change postoperative prophylaxis guidelines.
Methods: One hundred twenty-seven consecutive patients undergoing unilateral lower extremity flap harvest from June 2011 to December 2015 were retrospectively evaluated for the development of VTE. Each patient had a flap harvested from the lower extremity and inset into the abdomen or perineum and not the ipsilateral leg/foot/ankle. All patients with symptomatic leg pain received bilateral ultrasonographic evaluation for VTE formation. The contralateral, non-operative leg served as an internal control. Sixty comorbidity-matched patients who underwent perineal tumor extirpation without reconstruction provided an external control.
Results: Sixty patients were male (47%) with mean age of 52 years. Mean follow-up was 339 days. All patients underwent flap reconstruction for an oncologic defect of the abdomen or perineum with 79% undergoing perineal reconstruction. Most patients underwent anterolateral thigh (41%) or gracilis flap (40%) harvest.
Eleven patients developed VTEs in either leg (9%), for a total of 15 episodes of VTE. Of these, 10 were donor site (66%) and 5 were contralateral leg (33%). There was a non-significant trend towards increased odds for the formation of donor-site VTE when compared with contralateral lower extremity (OR:1.7;CI:0.80-3.4;p=0.15).
Patients who underwent flap harvest had a 9 times higher odds of VTE formation when compared with their comorbidity matched controls who did not undergo flap reconstruction (OR:9.08;CI:1-82.6;p<0.05).
Conclusions: The rate of VTE is higher than previously appreciated for reconstructive procedures of the perineum that utilize lower extremity flaps. Routine surveillance or extended prophylaxis may be warranted.
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