Incidence of heparin-induced thrombocytopenia in lower-extremity free flap reconstruction correlates with the overall surgical population

被引:5
作者
Stimac, Gregory [1 ]
Walters, Elliot T. [2 ]
Elmarsafi, Tammer [2 ]
Attinger, Christopher [3 ]
Evans, Karen K. [3 ]
机构
[1] Georgetown Univ, Sch Med, 3900 Reservoir Rd NW, Washington, DC 20007 USA
[2] MedStar Georgetown Univ Hosp, Dept Plast Surg, Diabet Limb Salvage, 3800 Reservoir Rd NW, Washington, DC 20007 USA
[3] MedStar Georgetown Univ Hosp, Dept Plast Surg, 3800 Reservoir Rd NW, Washington, DC 20007 USA
关键词
Heparin-induced thrombocytopenia; Free flap reconstruction; HIT syndrome; Lower-extremity wound; FREE TISSUE TRANSFER; FAILURE; MANAGEMENT; THROMBOSIS; DIAGNOSIS; METAANALYSIS; SURGERY; SALVAGE; TRAUMA; SCORE;
D O I
10.1016/j.bjps.2018.05.034
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Lower-extremity free flap reconstruction is a growing trend in the management of lower extremity wounds. Heparin-induced thrombocytopenia (HIT) is a significant risk to free flap reconstruction. The purpose of this study was to investigate the incidence of HIT in patients receiving lower-extremity free flap surgery. Methods: We conducted a retrospective, single center, IRB approved cohort study in which we reviewed all patients who received lower-extremity free flap surgeries between 2011 and 2016. The 4T and HIT Expert Probability (HEP) scores were calculated to assess the likelihood of HIT. Results: One hundred patient charts revealed three patients with HIT. One patient was excluded due to a prior diagnosis of HIT. HIT incidence in patients receiving lower-extremity free flaps was between 1% and 3%, which is consistent with the national average. 4T scores indicated that two of three HIT-positive patients had a high probability of HIT (approximately 64%), and one of three HIT-positive patients had an intermediate probability (approximately 14%). HEP scoring indicated that all the three (100%) patients had HIT. Conclusions: These data suggest that the incidence of HIT in patients receiving lower-extremity free flaps correlates with the incidence of HIT nationally. The use of available scoring methods and other algorithms, combined with patient history helps to assess the immediate perioperative risks of HIT in the absence of rapid immunologic confirmatory tests. This knowledge can allow for successful free flap salvage or for performance of free flaps in patients with a history of HIT. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:1252 / 1259
页数:8
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