212 posters, 10 topics, 5 sessions, 754 authors, 237 institutions
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The AAPS 101st Annual Meeting
29 April – 2 May, 2023 | Chicago, IL
D39
Free Tissue Transfer To The Lower Extremity In The Setting Of Thrombocytosis And The Role Of Anti-platelet Therapy: A Retrospective Review
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Hand/Extremity
Free Tissue Transfer to the Lower Extremity in the Setting of Thrombocytosis and the Role of Antiplatelet Therapy: A Propensity-score Matched Analysis
Free flaps (FF) are a reliable reconstructive method for chronic lower extremity (LE) wounds, with flap survival reaching 99% at large-volume centers.1
Chronic wound patients are often on at-home antiplatelet (AP) medication (ASA, Plavix) in the setting of cardiac or vascular comorbidities.
Our institution previously demonstrated that continuing at-home AP medication on the day of LE FF can be safely performed.2
Concurrently, thrombosis-induced anastomotic occlusion remains the most common reason for FF failure à this risk is elevated in patients with thrombocytosis.3,4
Yet, remains unclear whether continuing at-home AP medication in thrombocytotic patients is protective against this increased risk
To:
1.Assess the overall feasibility of performing LE FF in patients with preoperative thrombocytosis
2.Characterize whether AP medication on the day of surgery (DOS) is beneficial in this patient population
Average patient age and body mass index (BMI) 57.8 ± 10.9 years and 28.9 ± 7.0 kg/m2, respectively
Average Charlson Comorbidity Index (CCI) score 4.3 ± 2.0, reflecting substantial comorbidity burden
No differences between cohorts in demographic or comorbidity covariates
No differences in vessel patency as measured by preoperative arteriography or endovascular interventions
Intraoperatively: No differences in wound location, donor site, flap composition, or anastomosis technique
Postoperatively: No differences in risk stratification or flap-related complications (e.g., infection, dehiscence, revision, take-back)
Findings limited by retrospective design and relatively small sample size, given rarity of thrombocytosis
Thrombocytosis categorization based on preoperative lab values, which were sometimes limited to single-point values
96.2% flap success rate à LE FF can be feasibly performed in high-risk patients with thrombocytosis
Possible short-term, minor bleeding risks
Despite much higher rates of calcified vessels in the AP medication group, thrombosis rates were similar à possibly beneficial to continue at-home AP medication in this patient population
Our institution’s practice:
1.If on at-home AP medication à continue on DOS
2.If not on at-home AP medication à do not initiate AP medication