title: Reactive thrombocytosis alone does not affect the patency of microvascular anastomosis in the splenectomy rat.
abstract: Vascular thrombosis is a harbinger of failure in microsurgery. However, there is still controversy regarding the correlation of the complications of thrombocytosis and thrombosis. Some evidence indicates that patients with elevated platelet counts tend to have a higher flap failure rate, and surgeons usually hesitate to operate on patients with thrombocytosis. Nevertheless, the authors have experienced successful free tissue transfer in seven patients with thrombocytosis resulting from traumatic splenectomy or multiple trauma. On the basis of clinical observation, the authors investigated whether reactive thrombocytosis contributes to the patency of a microvascular anastomosis. In a rodent splenectomy-induced thrombocytosis model (n = 40), stable reactive thrombocytosis occurred after postoperative days 5 to 10, with the peak on postoperative day 7. Femoral artery division and reanastomosis was performed in rats with or without splenectomy-induced thrombocytosis, and vascular patency was assessed. Platelet counts and platelet activation were studied in correlation to microvascular patency. Platelet activation as demonstrated by CD62P expression on platelets was not significantly different between rats with and without thrombocytosis (6.41 +/- 0.95 percent versus 4.51 +/- 0.55 percent, respectively; p = 0.089). As immature platelets were not increased (2.86 +/- 0.33 percent versus 1.99 +/- 0.32 percent, p = 0.074), it seems that the splenectomy-induced thrombocytosis is the result of redistribution of platelets instead of an increase in bone marrow production. There were no significant differences in the patency rates or perfusion units of femoral artery after arterial anastomosis between rats with and without thrombocytosis (90 percent and 95 percent, respectively; p = 0.561). In conclusion, this study demonstrates that microvascular anastomosis can be performed safely in patients with reactive thrombocytosis without platelet activation.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Kaohsiung, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan.
authors.forename: Yur-Ren
authors.initials: YR
authors.lastname: Kuo
authors.forename: Kuender D
authors.initials: KD
authors.lastname: Yang
authors.forename: Ming-Yi
authors.initials: MY
authors.lastname: Yang
authors.forename: Mong-Na Lo
authors.initials: MN
authors.lastname: Huang
authors.forename: Chein-Wei
authors.initials: CW
authors.lastname: Lin
authors.forename: Fu-Chein
authors.initials: FC
authors.lastname: Lin
authors.forename: Fu-Chan
authors.initials: FC
authors.lastname: Wei
authors.forename: Seng-Feng
authors.initials: SF
authors.lastname: Jeng
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D008297:Male; D008866:Microsurgery; D015539:Platelet Activation; D011183:Postoperative Complications / Q000503:physiopathology*; D051381:Rats; D011917:Rats, Inbred Lew; D013156:Splenectomy; D013922:Thrombocytosis / Q000097:blood / Q000503:physiopathology*; D014654:Vascular Patency; D014656:Vascular Surgical Procedures