title: Thromboprophylaxis in Abdominoplasty: Efficacy and Safety of a Complete Perioperative Protocol.
abstract: BACKGROUND
  Venous thromboembolism, a spectrum of diseases ranging from deep venous thrombosis to pulmonary embolism, is a major source of morbidity and mortality. The majority of cases described in plastic surgery involve abdominoplasty. Risk assessment and prophylaxis are paramount in such patients. General recommendations were recently developed, but the evidence in the literature was insufficient to prepare exhaustive guidelines regarding the medication, dosage, timing, or length of the prophylaxis.
  
  
  METHODS
  A thromboprophylaxis protocol was developed for patients undergoing abdominoplasty. The protocol consisted of preoperative, intraoperative, and postoperative measures. Enoxaparin was administered as chemoprophylaxis in selected patients. The study involved 253 patients. The patients were analyzed for age, body mass index, enoxaparin dosage, risk factors, and complications.
  
  
  RESULTS
  Deep venous thrombosis was documented in two cases (0.8%). No pulmonary embolism occurred. Three patients (1.2%) presented mild subcutaneous abdominal hematoma within the first postoperative week that spontaneously resorbed with neither aesthetic nor functional complications. Two patients (0.8%) presented severe hematoma requiring surgical re-intervention for drainage and hemostasis revision. Statistical analysis showed no significant correlation between enoxaparin dosage and hematoma (P=0.18) or deep venous thrombosis (P=0.61).
  
  
  CONCLUSIONS
  The described thromboprophylaxis protocol proved to be effective in the prevention of thrombotic events, with an acceptable risk of hemorrhagic complications. Furthermore, it provides new evidence regarding the currently debated variables of chemoprophylaxis, namely type, dosage, timing, and length.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University, Rome, Italy.
authors.forename: Giovanni Francesco
authors.initials: GF
authors.lastname: Marangi
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Segreto
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University, Rome, Italy.
authors.forename: Igor
authors.initials: I
authors.lastname: Poccia
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Campa
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Tosi
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Lamberti
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Persichetti
keywords: Abdominoplasty; Enoxaparin; Thromboembolism; Thrombosis; Venous thrombosis