PMID- 36928902
OWN - NLM
STAT- MEDLINE
DCOM- 20231228
LR  - 20240102
IS  - 1098-8947 (Electronic)
IS  - 0743-684X (Linking)
VI  - 40
IP  - 1
DP  - 2024 Jan
TI  - Free Tissue Transfer to the Lower Extremity in the Setting of Thrombocytosis and 
      the Role of Antiplatelet Therapy: A Propensity Score-Matched Analysis.
PG  - 40-49
LID - 10.1055/a-2056-1561 [doi]
AB  - BACKGROUND:  Free tissue transfer (FTT) provides a versatile method to achieve 
      successful lower limb salvage. Thrombocytosis in patients undergoing lower 
      extremity (LE) FTT is associated with increased risk of complications. The aims 
      of this study were to assess the feasibility of performing LE FTT in patients 
      with preoperative thrombocytosis, and whether antiplatelet (AP) therapy on the 
      day of surgery (DOS) affects outcomes. METHODS:  A retrospective review of 
      thrombocytotic patients who underwent LE FTT between 2011 and 2022 was performed. 
      Patients were stratified into groups based on the receipt of AP therapy on the 
      DOS. Patients were propensity score matched for comorbidity burden and 
      postoperative risk stratification. Outcomes of interest included perioperative 
      transfusion requirements, postoperative flap-related complications, rates of flap 
      success, limb salvage, and ambulatory status. RESULTS:  Of the 279 patients who 
      underwent LE FTT, 65 (23.3%) were found to have preoperative thrombocytosis. 
      Fifty-three patients remained following propensity score matching; of which, 32 
      (60.4%) received AP therapy on the DOS and 21 (39.6%) did not. Overall flap 
      success rate was 96.2% (n = 51). The likelihoods of thrombosis and hematoma 
      development were similar between cohorts (p = 0.949 and 0.574, respectively). 
      Receipt of DOS AP therapy was associated an additional 2.77 units and 990.10 mL 
      of transfused blood (p = 0.020 and 0.018, respectively). At a mean follow-up of 
      20.7 months, overall limb salvage and ambulatory rates were 81.1% (n = 43) and 
      79.2% (n = 42), respectively, with no differences between cohorts. CONCLUSION: 
       Preoperative thrombocytosis is not an absolute contraindication to LE FTT. DOS 
      AP therapy may be protective in comorbid patients with elevated platelet counts 
      but must be weighed against possible short-term bleeding as suggested by 
      significant increases in postoperative transfusion requirements.
CI  - Thieme. All rights reserved.
FAU - Berger, Lauren E
AU  - Berger LE
AUID- ORCID: 0000-0002-5747-0009
AD  - Department of Plastic and Reconstructive Surgery, MedStar Georgetown University 
      Hospital, Washington, District of Columbia.
AD  - Plastic and Reconstructive Surgery Division, Rutgers Robert Wood Johnson Medical 
      School, New Brunswick, New Jersey.
FAU - Huffman, Samuel S
AU  - Huffman SS
AUID- ORCID: 0000-0002-1779-8384
AD  - Department of Plastic and Reconstructive Surgery, MedStar Georgetown University 
      Hospital, Washington, District of Columbia.
AD  - Department of Plastic and Reconstructive Surgery, Georgetown University School of 
      Medicine, Washington, District of Columbia.
FAU - Bovill, John D
AU  - Bovill JD
AD  - Department of Plastic and Reconstructive Surgery, Georgetown University School of 
      Medicine, Washington, District of Columbia.
FAU - Spoer, Daisy L
AU  - Spoer DL
AUID- ORCID: 0000-0002-1735-5006
AD  - Department of Plastic and Reconstructive Surgery, MedStar Georgetown University 
      Hospital, Washington, District of Columbia.
AD  - Department of Plastic and Reconstructive Surgery, Georgetown University School of 
      Medicine, Washington, District of Columbia.
FAU - Shin, Stephanie
AU  - Shin S
AD  - Department of Plastic and Reconstructive Surgery, Georgetown University School of 
      Medicine, Washington, District of Columbia.
FAU - Truong, Brian N
AU  - Truong BN
AD  - Department of Plastic and Reconstructive Surgery, Georgetown University School of 
      Medicine, Washington, District of Columbia.
FAU - Gupta, Nisha
AU  - Gupta N
AD  - Department of Plastic and Reconstructive Surgery, Georgetown University School of 
      Medicine, Washington, District of Columbia.
FAU - Attinger, Christopher E
AU  - Attinger CE
AD  - Department of Plastic and Reconstructive Surgery, MedStar Georgetown University 
      Hospital, Washington, District of Columbia.
FAU - Akbari, Cameron M
AU  - Akbari CM
AD  - Department of Vascular Surgery, MedStar Georgetown University Hospital, 
      Washington, District of Columbia.
FAU - Evans, Karen K
AU  - Evans KK
AD  - Department of Plastic and Reconstructive Surgery, MedStar Georgetown University 
      Hospital, Washington, District of Columbia.
LA  - eng
PT  - Journal Article
DEP - 20230316
PL  - United States
TA  - J Reconstr Microsurg
JT  - Journal of reconstructive microsurgery
JID - 8502670
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Humans
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - *Free Tissue Flaps
MH  - Propensity Score
MH  - Treatment Outcome
MH  - Lower Extremity/surgery
MH  - Retrospective Studies
MH  - *Thrombocytosis
MH  - Postoperative Complications
COIS- None declared.
EDAT- 2023/03/18 06:00
MHDA- 2023/12/28 06:42
CRDT- 2023/03/17 09:36
PHST- 2023/12/28 06:42 [medline]
PHST- 2023/03/18 06:00 [pubmed]
PHST- 2023/03/17 09:36 [entrez]
AID - 10.1055/a-2056-1561 [doi]
PST - ppublish
SO  - J Reconstr Microsurg. 2024 Jan;40(1):40-49. doi: 10.1055/a-2056-1561. Epub 2023 
      Mar 16.