Heparin-induced thrombocytopenia syndrome as a cause of flap failure: a report of two cases.
BACKGROUND
Flap failure is a major complication in reconstructive plastic surgery. One of the most frequent etiologies of flap failure is venous thrombosis. However, infrequent causes also need to be explored, especially when faced with recurrent thrombosis. Heparin is frequently used in the prevention of venous thrombosis; however, the use of the medication itself may cause a serious thromboembolic state via an immune-related pathophysiological process. This adverse reaction to heparin may be life threatening.


METHODS
We present two cases, one pedicled and one free flap, with venous congestion concomitant to heparin-induced thrombocytopenia syndrome, in conjunction with severe life-threatening sequelae.


CONCLUSIONS
Heparin-induced thrombocytopenia syndrome can be the cause of postoperative venous congestion. It is necessary to be alert for this syndrome in the presence of recurrent unexplained venous thrombosis or thrombocytopenia in patients receiving anticoagulation therapy.
Tremblay
Dominique M
DM
Division of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, 1560 Sherbrooke Street E, G3132, Montréal, Québec, Canada H2L 4M1.
Harris
Patrick G
PG
Gagnon
Alain R
AR
Cordoba
Carlos
C
Brutus
Jean Paul
JP
Nikolis
Andreas
A
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000139:chemically induced*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000379:methods; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery; D011182:Postoperative Care / Q000009:adverse effects; D013524:Surgical Flaps / Q000098:blood supply / Q000473:pathology*; D013921:Thrombocytopenia / Q000139:chemically induced*; D020246:Venous Thrombosis / Q000139:chemically induced
D000925:Anticoagulants; D006493:Heparin