title: Factor V Leiden associated with flap loss in microsurgical breast reconstruction.
abstract: Two cases are reported of flap loss following microsurgical perforator flap breast reconstruction in patients diagnosed with a factor V Leiden mutation. Factor V Leiden is the most common inherited cause of hypercoagulability, leading to an increased risk of thrombotic events. The first patient underwent a deep inferior epigastric artery perforator flap and then had recurrent arterial thrombosis both intraoperatively and postoperatively. This patient was subsequently diagnosed with a factor V Leiden mutation. The second patient had a known factor V Leiden mutation and underwent a superior gluteal artery perforator flap, which developed thrombosis and flap loss 2 days later. Preoperative assessment of a personal or family history of unexplained venous or arterial thrombosis should prompt suspicion of a factor V Leiden mutation. This mutation places patients at high risk for thromboembolic events in microvascular breast reconstruction, particularly when oral contraceptives or tamoxifen are used in conjunction.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Khansa
authors.forename: Salih
authors.initials: S
authors.lastname: Colakoglu
authors.forename: David C
authors.initials: DC
authors.lastname: Tomich
authors.forename: Minh-Doan
authors.initials: MD
authors.lastname: Nguyen
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
mesh_terms: D005165:Factor V / Q000235:genetics*; D005260:Female; D058752:Free Tissue Flaps; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000235:genetics*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery; D008875:Middle Aged; D017354:Point Mutation; D013927:Thrombosis / Q000175:diagnosis / Q000235:genetics*
chemical_list: C095381:factor V Leiden; D005165:Factor V