Annals of plastic surgery
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Annals of plastic surgery · Jan 2014
Maximizing chemoprophylaxis against venous thromboembolism in abdominoplasty patients with the use of preoperative heparin administration.
Abdominoplasty is one of the highest risk plastic surgery procedures for venous thromboembolism complications (VTE). Current recommendations for VTE prophylaxis are sequential compression devices (SCDs) in the OR and optional use of subcutaneous heparin after surgery. Subcutaneous heparin has been shown to be safe in other surgical groups. However, the large raw surface areas and dissection involved in abdominoplasty has been a relative contraindication for preoperative chemoprophylaxis. However, the period while the patient is under general anesthesia and immediately following the procedure is likely the highest risk time period for VTEs. The purpose of this study is to determine if preoperative chemoprophylaxis is safe in these patients. ⋯ The use of preoperative chemoprophylaxis in patients undergoing abdominoplasty can be done without an increase in bleeding complications or overall complication rate. Furthermore, enoxaparin can also be used preoperatively and continued for 2 more days during the period of time of maximum immobility with easy administration for outpatients via use of a prescription home use kit.
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Annals of plastic surgery · Jan 2014
Early postoperative outcomes associated with the anterolateral thigh flap in Gustilo IIIB fractures of the lower extremity.
A core concept in plastic surgery has been the replacement of "like-with-like" tissue. Applying this concept to the lower extremity, the anterolateral thigh (ALT) perforator flap has become a frequently used free flap for restoration of soft tissue defects involving the distal lower extremity. The objective of this study was to evaluate the rate of early postoperative complications associated with the ALT perforator free flap for coverage of high-energy traumatic open fractures of the lower extremity (Gustilo IIIB) and explore related patient risk factors. ⋯ In this retrospective review, those patients who had a positive history of tobacco use at the time of injury and those with risk factors for atherosclerosis had a significantly increased risk of flap complications. Although this is not surprising given the vasoconstrictive effects of nicotine and the impaired blood flow to the lower extremity in patients with atherosclerosis, this study will allow the surgeon to better counsel patients who have a history of tobacco use through complex reconstruction of the lower extremity. This analysis is a preliminary investigation into the safety and efficacy of the ALT fasciocutaneous or adipocutaneous flap to reconstruct high-energy open fractures of the lower extremity.