Markers of blood coagulation and fibrinolysis in patients with early and delayed microsurgical reconstructions in the lower extremities.
BACKGROUND
In this study, markers of coagulation and fibrinolysis were assessed during early and delayed microsurgical reconstruction in patients with traumatic defects of their lower legs to analyse whether an imbalance of the hemostasis after trauma might predispose the development of vascular complications.


METHODS
The prospective study included 70 patients. In 35 patients, surgery was performed within 72 hours after injury. In 35 other patients, delayed free flap transfer was performed between 14-21 days after trauma. In each group, reconstruction was performed with a fasciocutaneous anterior-lateral thigh flap (ALT, n = 18) or a myocutaneous flap (latissimus dorsi flap; n = 17). Blood samples were collected preoperatively, intraoperatively, and 3, 6, 12, 24, 36, 48, 72, 96 and 120 hours after the operation. Analysed parameters included markers of coagulation such as prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin III-complex (TAT), and antithrombin, as well as fibrinolysis markers such as plasminogenactivator inhibitor-I (PAI-1), tissue-plasminogenactivator (t-PA), and plasminogen.


RESULTS
Preoperatively, levels of F1 + 2, TAT, and PAI-1 were significantly higher in patients with delayed reconstruction (p < .05). Patients with later vascular complications in this group (n = 5) presented a significant higher concentration of TAT, F1 + 2, and PAI-1 (p < .05). Twelve and 24 hours after free flap surgery, patients with vascular complications presented significant elevated levels of these markers (p < .05).


CONCLUSIONS
Patients with delayed free flap surgery after lower leg trauma present a hypercoagulable state in their blood due to activation of the coagulation system and hypofibrinolysis. Early reconstruction might minimise the risk of flap failure caused by hypercoagulability.
a Department of Hand, Plastic and Reconstructive Surgery , Radboud University Hospital , Nijmegen , The Netherlands.
Oliver
O
Kloeters
a Department of Hand, Plastic and Reconstructive Surgery , Radboud University Hospital , Nijmegen , The Netherlands.
Dalibor
D
Vasilic
a Department of Hand, Plastic and Reconstructive Surgery , Radboud University Hospital , Nijmegen , The Netherlands.
Pieter
P
Hupkens
a Department of Hand, Plastic and Reconstructive Surgery , Radboud University Hospital , Nijmegen , The Netherlands.|b Department of Plastic and Reconstructive Surgery , University Hospital, Aachen University of Technology , Aachen , Germany.
Dietmar
D
Ulrich
D001777:Blood Coagulation; D005260:Female; D005342:Fibrinolysis; D058752:Free Tissue Flaps / Q000009:adverse effects; D006801:Humans; D007869:Leg Injuries / Q000097:blood / Q000150:complications / Q000601:surgery*; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D019851:Thrombophilia / Q000175:diagnosis / Q000209:etiology*; D061665:Time-to-Treatment; D017211:Treatment Failure
Fibrinolysis; coagulation; complication; extremity; free flap; microsurgery; reconstruction; thrombosis