Preoperative Deep and Superficial Venous Thrombosis in Limb Salvage Candidates: A Contraindication to Microsurgical Free Flap Reconstruction? Lessons Learned from Our 13-year Institutional Experience.
Research article published in Journal of reconstructive microsurgery (2025)
Abstract
Although arterial inflow considerations dominate microsurgical planning, venous outflow is equally vital for flap survival. Patients requiring free tissue transfer (FTT) for lower extremity (LE) reconstruction frequently present with occult preoperative venous thrombosis (VT), yet there are little data guiding perioperative management in this setting. This study examines the prevalence and clinical characteristics of patients with preoperative venous thrombosis (VT) undergoing LE FTT, as well as postoperative outcomes, to evaluate the feasibility of successful microsurgery in this high-risk cohort.A retrospective review of patients with preoperative VT undergoing LE FTT at a single institution was conducted.Among 279 patients, 43 (15.4%) were positive for VT. The overall deep VT (DVT) incidence in this population was 5.7% (n = 16/279) and the superficial VT (SVT) incidence was 10.0% (n = 28/279). Most thromboses were chronic (67.8%). There were two cases of takeback (4.7%) due to thrombosis (one arterial and one venous), of which one flap was salvaged. By a median follow-up duration of 9.7 months, a limb salvage rate of 88.4% was achieved.Preoperative VT is common in microsurgical candidates for limb salvage; however, it is not a contraindication to FTT if proper adjustments are made perioperatively. Considerations include (1) routine use of venous ultrasound to identify VT; (2) perioperative anticoagulation management, including IVC filter placement when indicated; (3) selection of recipient veins that are unaffected by VT; (4) prioritizing the use of two deep veins for anastomosis when feasible; and (5) incorporating implantable devices to monitor venous outflow.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Although arterial inflow considerations dominate microsurgical planning, venous outflow is equally vital for flap survival. Patients requiring free tissue transfer (FTT) for lower extremity (LE) reconstruction frequently present with occult preoperative venous thrombosis (VT), yet there are little...
Warum dies für die Hirudotherapie relevant ist
This retrospective single-institution review examined 43 patients with preoperative venous thrombosis among 279 undergoing lower extremity free tissue transfer, finding that 15.4% had preoperative VT (5.7% deep, 10.0% superficial), with a limb salvage rate of 88.4% and only two thrombosis-related takebacks (4.7%). The authors conclude that preoperative VT is common but not an absolute contraindication to microsurgical reconstruction with appropriate perioperative adjustments. The study has indirect contextual relevance to ASH's domain because lower extremity free flap reconstruction is a clinical setting where leech therapy may be applied for salvage, though this abstract does not reference leeches, hirudin, or bivalirudin. Caveat: This is a single-center retrospective study focused on venous thrombosis management; there is no direct involvement of leech therapy, the leech secretome, or leech-derived compounds.
Zitation
Preoperative Deep and Superficial Venous Thrombosis in Limb Salvage Candidates: A Contraindication to Microsurgical Free Flap Reconstruction? Lessons Learned from Our 13-year Institutional Experience.
Rohrich et al. · Journal of reconstructive microsurgery, 2025
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