ABSTRACT
OBJECTIVES: The aim of this prospective study was to determine laboratory parameters predicting complications and/or failure in flap surgery. STUDY DESIGN: Fifty-seven patients undergoing reconstructive surgery with cutaneous free and pedicled flaps were included. Blood samples were taken 2 days before surgery and 1, 3, 5, 7, and 14 days after. Parameters associated with thrombophilia, bleeding disorders, and wound healing were determined. RESULTS: In 45 (77%) of 57 patients no complications occurred. Bleeding (9%) and venous thrombosis of the flaps (9%) led in 18% of the cases to surgical revisions. Activated protein C resistance showed a significant (P < .05) cluster in cases with venous thrombosis, whereas it was absent in all other cases. Fibrinogen, factor VIII:C, von Willebrand factor (vWF) activity, and VWF antigen were significantly (P < .05) higher in patients with venous thrombosis compared with all other patients. CONCLUSIONS: Laboratory parameters of thrombosis and bleeding appear to be associated with complications in flap surgery.
Subject(s)
Plastic Surgery Procedures , Postoperative Complications , Surgical Flaps , Activated Protein C Resistance/etiology , Blood Coagulation Tests , C-Reactive Protein/analysis , Factor VIII/analysis , Female , Fibrinogen/analysis , Follow-Up Studies , Forecasting , Free Tissue Flaps/adverse effects , Hematologic Tests , Hemorrhagic Disorders/blood , Humans , Male , Necrosis , Platelet Function Tests , Postoperative Hemorrhage/etiology , Prospective Studies , Plastic Surgery Procedures/adverse effects , Reoperation , Skin Transplantation/adverse effects , Surgical Flaps/adverse effects , Thrombophilia/blood , Thrombosis/blood , Thrombosis/etiology , Venous Thrombosis/blood , Venous Thrombosis/etiology , von Willebrand Factor/analysis , von Willebrand Factor/immunologyABSTRACT
Neonatal alloimmune thrombocytopenia (NAIT) is a fetomaternal incompatibility most commonly induced by maternal anti-HPA-1a, IgG alloantibodies against a polymorphic epitope of the glycoprotein IIb/IIIa complex in approximately 97.5% of white patients. Current guidelines recommend transfusion of immunologically compatible platelets to prevent cerebral hemorrhage, the most severe complication in affected newborns. Such platelet concentrates, however, are often not readily available. In a retrospective analysis in German and Canadian centers, 27 newborns with NAIT were identified who received platelets from random donors. Unexpectedly, 24 of 27 newborns showed an increase above a threshold of 40 x 10(9) platelets per liter, with moderate (n = 8) or significant (n = 16) platelet count increments (more than 80 x 10(9)/L). We conclude that transfusion of platelet concentrates from random donors is an appropriate strategy in the management of unexpected, severe NAIT predominantly in first pregnancies, pending the availability of compatible platelets.
