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Breast Reconstruction with Free Abdominal Flaps Is Associated with Persistent Lower Extremity Venous Stasis

Momeni, Arash, M.D.; Sorice, Sarah C., M.D.; Li, Alexander Y., M.D., M.S.; Nguyen, Dung H., M.D.; Pannucci, Christopher, M.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1144e–1150e
doi: 10.1097/PRS.0000000000005613
Breast: Original Articles
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Background: Previous work has demonstrated the occurrence of lower extremity venous stasis in the early postoperative period after breast reconstruction with free abdominal flaps. The authors investigated whether venous stasis persisted through the day of discharge, thus potentially exposing patients to an elevated risk of venous thromboembolism following discharge.

Methods: Patients who underwent breast reconstruction with free abdominal flaps were enrolled prospectively and underwent duplex ultrasound of the common femoral vein at the following time points: preoperatively, postoperative day 1, and day of discharge. Parameters of interest included common femoral vein diameter, area, and maximum flow velocity.

Results: Thirty patients with a mean age of 50.3 years (range, 29 to 70 years) underwent breast reconstruction with 52 free abdominal flaps. A significant increase in common femoral vein diameter (19.1 percent; p < 0.01) and area (46.8 percent; p < 0.01) correlated with a significant reduction in maximum flow velocity (−10.9 percent; p = 0.03) between baseline and postoperative day 1. These changes persisted through the day of discharge [common femoral vein diameter, 17.8 percent (p < 0.01); area, 46 percent (p < 0.01); and maximum flow velocity, −11.3 percent (p = 0.01)]. Venous parameters were not influenced by unilateral versus bilateral flap harvest (p = 0.48).

Conclusions: Postoperative lower extremity venous stasis following autologous breast reconstruction with free abdominal flaps seems to persist through the day of discharge. This finding may explain why patients remain at risk for venous thromboembolism after discharge. Although the authors’ findings are at odds with current venous thromboembolism prophylaxis recommendations, additional studies are indicated to examine whether these findings translate into venous thromboembolism events.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Palo Alto, Calif.; and Salt Lake City, Utah

From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center; and the Division of Plastic Surgery, University of Utah.

Received for publication May 2, 2018; accepted October 17, 2018.

This trial is registered under the name “Microsurgical Breast Reconstruction & VTE,” ClinicalTrials.gov identification number NCT03031457 (https://clinicaltrials.gov/ct2/show/NCT03031457).

Disclosure:Dr. Momeni is a consultant for Allergan, AxoGen, Sientra, and Stryker. None of the authors have any conflicts of interest to disclose related to the content of the article. No payment was received for the study.

Arash Momeni, M.D., Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, Calif. 04304, amomeni@stanford.edu

©2019American Society of Plastic Surgeons