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.
Resumen
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...
Por qué esto importa para la hirudoterapia
Esta revisión retrospectiva de una sola institución examinó a 43 pacientes con trombosis venosa preoperatoria entre 279 sometidos a transferencia de tejido libre de extremidad inferior, encontrando que el 15,4% presentaban TV preoperatoria (5,7% profunda, 10,0% superficial), con una tasa de salvamento de la extremidad del 88,4% y solo dos reintervenciones relacionadas con trombosis (4,7%). Los autores concluyen que la TV preoperatoria es frecuente pero no es una contraindicación absoluta para la reconstrucción microquirúrgica con los ajustes perioperatorios apropiados. El estudio tiene relevancia contextual indirecta para el ámbito de ASH porque la reconstrucción con colgajo libre de extremidad inferior es un escenario clínico donde la terapia con sanguijuelas puede aplicarse para salvamento, aunque este resumen no hace referencia a sanguijuelas, hirudina ni bivalirudina. Advertencia: Se trata de un estudio retrospectivo unicéntrico centrado en el manejo de la trombosis venosa; no hay una participación directa de la terapia con sanguijuelas, el secretoma de sanguijuela ni compuestos derivados de sanguijuela.
Citación
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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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: 18 de junio de 2026