Venous thromboembolism events after breast reconstructions with DIEP free flaps in 192 consecutive case

• Published in: Annales de chirurgie plastique et esthétique 2018-02, Vol.63 (1), p.11-19
• Main Authors: Modarressi, A., Schettini, A.-V., Rüegg, E.M., Pittet-Cuénod, B.
• Format: Article
• Language: English
• Subjects: Adult; Anticoagulants - therapeutic use; Body Mass Index; Breast reconstruction; DIEP; Epigastric Arteries; Evénements thromboembolique veineux; Female; Free Tissue Flaps; Humans; Incidence; Length of Stay; Mammaplasty - adverse effects; Mammaplasty - methods; Middle Aged; Perforator Flap; Pulmonary Embolism - epidemiology; Pulmonary Embolism - etiology; Reconstruction mammaire; Retrospective Studies; Risk Assessment; Risk Factors; Smoking - adverse effects; Switzerland - epidemiology; Time Factors; Venous thromboembolism; Venous Thromboembolism - epidemiology; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control
• ISSN: 0294-1260; 1768-319X
• DOI: 10.1016/j.anplas.2017.11.001

Patient candidates for breast reconstruction with free deep inferior epigastric perforator flap (DIEP) may present several risk factors for venous thromboembolism (VTE). Risk identification is essential for appropriate VTE prophylaxis measures to be put in place. This study aims to investigate VTE incidence after DIEP flap breast reconstruction and to assess the accuracy of the Caprini Risk Assessment Model (RAM), which is the unique score validated to assess the VTE risk for plastic surgery procedures and identify patients at high VTE risk. A chart review was conducted of 192 consecutive patients who underwent breast reconstruction with a DIEP flap from 1999 to 2016. VTE rate was assessed and the Caprini score was calculated for each patient and correlated with the VTE incidence. During the 90 post-operative days, four patients presented a pulmonary embolism (2.1%) and two patients (1%) had deep venous thrombosis (overall VTE incidence of 3.1%). Most patients (92.2%) were assessed as high-risk (Caprini score >5) and all VTE occurred among this group. Apart from the Caprini score, no specific single risk factor could be identified for VTE. Our data confirm that the Caprini RAM is a valuable assessment tool for VTE risk measurement among all patients undergoing autologous breast reconstruction. As most candidates for DIEP flap belong to the high-risk group, combined anticoagulation prophylaxis methods are required for most cases, particularly chemoprophylaxis up to four weeks postoperatively. Les patientes éligibles pour une reconstruction mammaire par lambeau libre abdominal basée sur l’artère épigastrique inférieure profonde (DIEP) peuvent présenter plusieurs facteurs de risque pour des événements thromboembolique veineux (ETV). Cette étude vise à évaluer l’incidence d’ETV après la reconstruction mammaire par DIEP et l’efficacité du score de Caprini pour identifier les patientes à risque d’ETV afin d’administrer une prophylaxie adéquate. Une étude rétrospective de 192 dossiers de patientes ayant bénéficié d’une reconstruction mammaire par DIEP entre 1999 et 2016 a été effectuée. Le taux d’EVT a été mesuré et le score de Caprini a été calculé pour chaque patiente. Durant les 90jours postopératoires, quatre patientes ont présenté une embolie pulmonaire (2,1 %) et deux patientes (1 %) une thrombose veineuse profonde (3,1 % d’incidence globale d’ETV). La majorité des patientes (92,2 %) a été classée à haut risque (Caprini>5) et toutes les ETV se sont produite