Free flap loss caused by heparin-induced thrombocytopenia and thrombosis (HITT): a case report and literature review.
Heparin-induced thrombocytopenia and thrombosis (HITT) represents a dramatic condition that is difficult to diagnose because of nuanced clinical presentation. Therefore, in every case of microvascular thrombosis during heparin-therapy prompt suspicion about HITT is necessary to avoid flap necrosis. We present a case of HITT which, as the 8 other articles reviewed, clearly shows that HITT is difficult to diagnose and complex to manage. Microvascular reconstruction is the first choice in head and neck reconstruction; unfortunately, dramatic outcomes in free flap surgery due to unpredictable thrombotic events are still reported in the English literature. More knowledge is required about HITT and reaching a consensus about thrombotic prevention in microsurgery could be helpful. Furthermore, a careful anamnesis can help minimise unexpected situations.
Chirurgia Maxillo-facciale e Odontostomatologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
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Segna
Chirurgia Maxillo-facciale e Odontostomatologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
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Bolzoni
Chirurgia Maxillo-facciale e Odontostomatologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
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Baserga
Chirurgia Maxillo-facciale e Odontostomatologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
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Baj
D000328:Adult; D058752:Free Tissue Flaps; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000139:chemically induced*; D013921:Thrombocytopenia / Q000139:chemically induced*; D013927:Thrombosis / Q000139:chemically induced*
D006493:Heparin
Blood coagulation disorder; Drug-related side effects and adverse reactions; Microsurgical free flap; Thrombosis