Hereditary thrombophilia in free microvascular flaps - A case report

Hereditary thrombophilia sums up a large number of haemostatic disorders, which cause thrombosis independently to external influences. The main cases of hereditary thrombophilias are the hereditary antithrombin defect, the activated protein C resistance, the hereditary protein C defect, the hereditary protein S defect, the antiphospholipid antibody syndrome, the hyperhomocysteinaemia, the increased factor VIII activity and the prothrombin-G20210A-polymorphism. We present a patient who was amputated in both breasts due to cancer. A bilateral microvascular TRAM-flap was planned as primary reconstruction on one breast and secondar reconstruction on the other breast. However in the operation the flap vessels revealed irreversible thromboses so that the intended reconstruction could not be completed in this operation. Postoperatively, a combined hereditary thrombophilia was diagnosed: heterocygote activated protein C resistance, antiphospholipid antibody syndrome and hyperhomocysteinaemia.