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Preoperative Platelet Count Predicts Lower Extremity Free Flap Thrombosis: A Multi-Institutional Experience.

Publication ,  Journal Article
Cho, EH; Bauder, AR; Centkowski, S; Shammas, RL; Mundy, L; Kovach, SJ; Levin, LS; Hollenbeck, ST
Published in: Plast Reconstr Surg
January 2017

BACKGROUND: Thrombocytosis in patients undergoing lower extremity free tissue transfer may be associated with increased risk of microvascular complications. This study assessed whether preoperative platelet counts predict lower extremity free flap thrombosis. METHODS: All patients undergoing lower extremity free tissue transfer at Duke University from 1997 to 2013 and at the University of Pennsylvania from 2002 to 2013 were retrospectively identified. Logistic regression was used to assess whether preoperative platelet counts independently predict flap thrombosis, controlling for baseline and operative factors. RESULTS: A total of 565 patients underwent lower extremity free tissue transfer, with an overall flap thrombosis rate of 16 percent (n = 91). Elevated preoperative platelet counts were independently associated with both intraoperative thrombosis (500 ± 120 versus 316 ± 144 × 10/liter; p < 0.001) and postoperative thrombosis (410 ± 183 versus 320 ± 143 × 10/liter; p = 0.040) in 215 patients who sustained acute lower extremity trauma within 30 days before reconstruction. In acute trauma patients, preoperative platelet counts predicted a four-fold increased risk of intraoperative thrombosis (cutoff value, 403 × 10/liter; OR, 4.08; p < 0.001) and a two-fold increased risk of postoperative thrombosis (cutoff value, 361 × 10/liter; OR, 2.16; p = 0.005). In patients who did not sustain acute trauma, preoperative platelet counts predicted a four-fold increased risk of intraoperative thrombosis (cutoff value, 352 × 10/liter; OR, 3.82; p = 0.002). CONCLUSIONS: Acute trauma patients with elevated preoperative platelet counts are at increased risk for lower extremity free flap complications. Prospective evaluation is warranted for guiding risk stratification and targeted treatment strategies. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Duke Scholars

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Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

January 2017

Volume

139

Issue

1

Start / End Page

220 / 230

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Thrombosis
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Preoperative Period
  • Postoperative Complications
  • Platelet Count
  • Plastic Surgery Procedures
  • Middle Aged
 

Citation

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Cho, E. H., Bauder, A. R., Centkowski, S., Shammas, R. L., Mundy, L., Kovach, S. J., … Hollenbeck, S. T. (2017). Preoperative Platelet Count Predicts Lower Extremity Free Flap Thrombosis: A Multi-Institutional Experience. Plast Reconstr Surg, 139(1), 220–230. https://doi.org/10.1097/PRS.0000000000002893
Cho, Eugenia H., Andrew R. Bauder, Sierra Centkowski, Ronnie L. Shammas, Lily Mundy, Stephen J. Kovach, L Scott Levin, and Scott T. Hollenbeck. “Preoperative Platelet Count Predicts Lower Extremity Free Flap Thrombosis: A Multi-Institutional Experience.Plast Reconstr Surg 139, no. 1 (January 2017): 220–30. https://doi.org/10.1097/PRS.0000000000002893.
Cho EH, Bauder AR, Centkowski S, Shammas RL, Mundy L, Kovach SJ, et al. Preoperative Platelet Count Predicts Lower Extremity Free Flap Thrombosis: A Multi-Institutional Experience. Plast Reconstr Surg. 2017 Jan;139(1):220–30.
Cho, Eugenia H., et al. “Preoperative Platelet Count Predicts Lower Extremity Free Flap Thrombosis: A Multi-Institutional Experience.Plast Reconstr Surg, vol. 139, no. 1, Jan. 2017, pp. 220–30. Pubmed, doi:10.1097/PRS.0000000000002893.
Cho EH, Bauder AR, Centkowski S, Shammas RL, Mundy L, Kovach SJ, Levin LS, Hollenbeck ST. Preoperative Platelet Count Predicts Lower Extremity Free Flap Thrombosis: A Multi-Institutional Experience. Plast Reconstr Surg. 2017 Jan;139(1):220–230.

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

January 2017

Volume

139

Issue

1

Start / End Page

220 / 230

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Thrombosis
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Preoperative Period
  • Postoperative Complications
  • Platelet Count
  • Plastic Surgery Procedures
  • Middle Aged