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Incidence of DVT and PE in War-Injured Extremity Flap Cohort
Ian L. Valerio, MD, MS, MBA; Reed Heckert, MD; Scott Tintle, MD; Mark Fleming, DO, and Anand Kumar, MD
Walter Reed National Military Medical Center
2012-02-12
Presenter: Scott Tintle
Affidavit:
Approximately 50%
Director Name: Scott Shawen, MD and Ian Valerio, MD
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: General Reconstruction
How does this presentation meet the established conference educational objectives?
Addresses objectives 2 and 3 with assessing data to manage and treat while improving care in high risk patient group while also presenting the largest series of flap cases in setting of known DVT or PE
How will your presentation be used by practicing physicians in the audience?
Will provide our successful algorithm of treating extremity trauma requiring flap coverage despite known DVT/PE with high success rates
Introduction: The recent war conflicts have provided a high volume of extremity reconstruction cases. Our war wounded often present with multiple amputations, long-bone fractures, and extensive soft tissue injury. These patients have many independent risk factors for developing deep vein thromboses (DVTs) and pulmonary emboli (PEs).
Methods: A retrospective review of flap procedures for combat extremity injuries from 2004-2011 was performed with interest of determining the incidence of DVT and/or PE. Outcomes evaluated in the DVT/PE cohort included flap success rate and complications such as rates of partial/total flap failure and donor and/or recipient site hematomas.
Results: Of the 137 extremity flaps performed (76 pedicle; 61 free flaps, respectively), 22 patients (16.1%) had preoperative DVT and/or PE (11 pedicle; 11 free flap cases). Weight based therapeutic LMWH was utilized in 15 cases (68.2%), heparin drip in 2 cases (8.9%), and remaining 5 patients (22.7%) received an IVC filter alone. Duration of therapy prior to flap coverage averaged 16 days (range 4-50days). Complications in the DVT/PE cohort included 1 partial flap necrosis (9% of free flaps), 1 recipient site hematoma (9% of free flap), and no total flap failures, donor site hematomas, or infections. No adverse outcome secondary to progression of an existing DVT or PE occurred.
Conclusion: The incidence of DVT and/or PE in war-injured patients requiring extremity flap coverage exceeded 16% in our series. Despite these preoperative thrombotic events, flap transfers, particularly free tissue transfers, can be performed safely and effectively in carefully selected cases.
