Multicentric study of thrombosis prevention in upper-extremity microsurgery. Survey at the Fesum centers

• Published in: Chirurgie de la main 2010-04, Vol.29 (2), p.100-108
• Main Authors: Dumont, L-A, Rongières, M, Tchénio, P, Gangloff, D, Garrido-Stowhas, I
• Format: Article
• Language: fre
• Subjects: Aspirin - therapeutic use; Drug Monitoring - methods; Evidence-Based Practice; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; France - epidemiology; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Hemorrhage - prevention & control; Heparin - therapeutic use; Humans; Microsurgery - adverse effects; Microsurgery - methods; Microsurgery - statistics & numerical data; Perioperative Care - methods; Platelet Aggregation Inhibitors - therapeutic use; Practice Patterns, Physicians' - organization & administration; Pyrrolidines - therapeutic use; Research Design; Risk Factors; Skin Transplantation - adverse effects; Skin Transplantation - methods; Surgical Flaps; Thrombosis - epidemiology; Thrombosis - etiology; Thrombosis - prevention & control; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Upper Extremity - surgery
• ISSN: 1769-6666
• DOI: 10.1016/j.main.2010.02.005

Thrombosis is still the first cause of microsurgery failure. Lots of publications have been made but no consensus exists. We first analysed the results of our study in 53 French expert surgeons, then we compared them with the last published datas, most of all, with the similar surveys. If a big majority (81 %) of the surgeons use a preventing method, we observed majors variations between them and also compared to the anglosaxons surgeons habits. This survey permits to make the point on today's practice and to show that some of them are based on low proof level and something even done without any medical references. After datas analysis, we observed that none of the medical treatments proved efficiency on preventing vascular thrombosis. The low molecular weight heparins (LMWH) could be used on postops without increase bleeding but not to lower specially the microvascular thrombosis rate. Aspirin did not improve the positive rates and its adjonction to LMWH increased the bleeding. Until scientific studies prove efficacy of a treatment, the surgeon has to make a personal choice: keeping habits or following evidence-based medicine.