Increased Incidence of Symptomatic Deep Venous Thrombosis Following Lower Extremity Flap Harvest for Abdominal and Perineal Reconstruction: A Case for Extended Surveillance
Justin M. Broyles, MD, Gurjot S. Walia, BS, Ricardo Bello, MD, MPH, Hannah M. Carl, BS, Rachel A. Pedriera, BA, Brian Cho, MD, WP Andrew Lee, MD, Justin M. Sacks, MD, MBA.
The Johns Hopkins Hospital, Baltimore, MD, USA.
PURPOSE: Venous thromboembolism (VTE) remains a leading cause of morbidity and data to support prophylaxis guidelines in lower extremity flap surgery are lacking. This study aims to identify the incidence of VTE in patients undergoing harvest of lower extremity flaps and define factors which could modify prophylaxis guidelines.
METHODS: One hundred twenty-seven patients undergoing lower extremity flap harvest were evaluated. Each patient had a flap harvested from the leg and inset in the perineum or abdomen. The contralateral, non-operative leg served as an internal control. Sixty comorbidity-matched patients who underwent perineal tumor extirpation without reconstruction provided an external control.
RESULTS: Sixty patients were male (47%) with mean age of 52 years. Mean follow-up was 339 days. All patients underwent flap reconstruction for an oncologic defect with 79% undergoing perineal reconstruction. Most patients underwent anterolateral thigh (41%) or gracilis flap (40%) harvest. Eleven patients developed VTEs in either leg (9%), for a total of 15 episodes of VTE. Of these, 10 were donor site (66%) and 5 were contralateral leg (33%).
Patients who underwent flap harvest had a 9 times higher odds of VTE formation when compared with their comorbidity matched controls who did not undergo flap reconstruction (OR:9.08;CI:1-82.6;p<0.05). There was a non-significant trend towards increased odds for the formation of donor-site VTE when compared with the contralateral lower extremity (OR:1.7;CI:0.80-3.4;p=0.15).
CONSLUSIONS: The rate of VTE is higher than previously appreciated for reconstructive procedures of the perineum that utilize lower extremity flaps. Routine surveillance or extended prophylaxis may be warranted.
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