Breast Reconstruction with Free Abdominal Flaps is associated with Persistent Lower Extremity Venous Stasis. Plastic and reconstructive surgery Momeni, A., Sorice, S. C., Li, A. Y., Nguyen, D. H., Pannucci, C. 2019


BACKGROUND: Previous work has demonstrated the occurrence of lower extremity venous stasis in the early postoperative period after breast reconstruction with free abdominal flaps. The purpose of this study was to ascertain whether venous stasis persisted through the day of discharge (DOD), thus, potentially exposing patients to an elevated risk of venous thromboembolism (VTE) post-discharge.METHODS: Patients who underwent breast reconstruction with free abdominal flaps were prospectively enrolled and underwent Duplex ultrasound of the common femoral vein (CFV) at the following time points: Preoperatively, POD 1, and DOD. Parameters of interest included CFV diameter, area, and maximum flow velocity (MFV).RESULTS: Thirty patients with a mean age of 50.3 years (range, 29 - 70) underwent breast reconstruction with 52 free abdominal flaps. A significant increase in CFV diameter (19.1%; p < 0.01) and area (46.8%; p < 0.01) correlated with a significant reduction in MFV (-10.9%; p = 0.03) between baseline and POD1. These changes persisted through the DOD (CFV diameter [17.8%; p < 0.01], area [46 %; p < 0.01], MFV (-11.3%; p = 0.01)]. Venous parameters were not influenced by uni- vs. bilateral flap harvest (p = 0.48).CONCLUSION: Postoperative lower extremity venous stasis following autologous breast reconstruction with free abdominal flaps seems to persist through the day of discharge. This finding may explain why patients remain at risk for VTE post-discharge. While our findings are at odds with current VTE prophylaxis recommendations, additional studies are indicated to examine whether these findings translate into VTE events.

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