Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Thromboprophylaxis in Abdominoplasty: Efficacy and Safety of a Complete Perioperative Protocol

  • Marangi, Giovanni Francesco (Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University) ;
  • Segreto, Francesco (Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University) ;
  • Poccia, Igor (Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University) ;
  • Campa, Stefano (Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University) ;
  • Tosi, Daniele (Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University) ;
  • Lamberti, Daniela (Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University) ;
  • Persichetti, Paolo (Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico di Roma University)
  • Received : 2015.10.18
  • Accepted : 2016.05.24
  • Published : 2016.07.20
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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.

Keywords

References

  1. American Society of Plastic Surgeons. Procedural statistics [Internet]. Arlington Heights, IL: American Society of Plastic Surgeons; 2015 [cited 2016 Jan 17]. Available from: http: //www.plasticsurgery.org/Documents/news-resources/statistics/2014-statistics/plastic-surgery-statsitics-full-report.pdf.
  2. Miszkiewicz K, Perreault I, Landes G, et al. Venous thromboembolism in plastic surgery: incidence, current practice and recommendations. J Plast Reconstr Aesthet Surg 2009; 62:580-8. https://doi.org/10.1016/j.bjps.2008.11.109
  3. Murphy RX Jr, Alderman A, Gutowski K, et al. Evidence-based practices for thromboembolism prevention: summary of the ASPS Venous Thromboembolism Task Force Report. Plast Reconstr Surg 2012;130:168e-175e. https://doi.org/10.1097/PRS.0b013e318254b4ee
  4. Pitanguy I, Mayer B, Labrakis G. Abdominoplasty: personal surgical guidelines. Zentralbl Chir 1988;113:765-71.
  5. Biorserud C, Olbers T, Fagevik Olsen M. Patients’ experience of surplus skin after laparoscopic gastric bypass. Obes Surg 2011;21:273-7. https://doi.org/10.1007/s11695-009-9849-z
  6. Iverson RE, Gomez JL. Deep venous thrombosis: prevention and management. Clin Plast Surg 2013;40:389-98. https://doi.org/10.1016/j.cps.2013.04.002
  7. Young VL, Watson ME. The need for venous thromboembolism (VTE) prophylaxis in plastic surgery. Aesthet Surg J 2006;26:157-75. https://doi.org/10.1016/j.asj.2006.02.001
  8. Seruya M, Baker SB. MOC-PS(SM) CME article: venous thromboembolism prophylaxis in plastic surgery patients. Plast Reconstr Surg 2008;122:1-9.
  9. Staalesen T, Elander A, Strandell A, et al. A systematic review of outcomes of abdominoplasty. J Plast Surg Hand Surg 2012; 46:139-44. https://doi.org/10.3109/2000656X.2012.683794
  10. Winocour J, Gupta V, Ramirez JR, et al. Abdominoplasty: Risk Factors, Complication Rates, and Safety of Combined Procedures. Plast Reconstr Surg 2015;136:597e-606e. https://doi.org/10.1097/PRS.0000000000001700
  11. Pannucci CJ, Bailey SH, Dreszer G, et al. Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients. J Am Coll Surg 2011;212:105-12. https://doi.org/10.1016/j.jamcollsurg.2010.08.018
  12. Hatef DA, Kenkel JM, Nguyen MQ, et al. Thromboembolic risk assessment and the efficacy of enoxaparin prophylaxis in excisional body contouring surgery. Plast Reconstr Surg 2008;122:269-79. https://doi.org/10.1097/PRS.0b013e3181773d4a
  13. Dini GM, Ferreira MC, Albuquerque LG, et al. How safe is thromboprophylaxis in abdominoplasty? Plast Reconstr Surg 2012;130:851e-857e. https://doi.org/10.1097/PRS.0b013e31826d9fc0
  14. Glynn RJ, Rosner B. Comparison of risk factors for the competing risks of coronary heart disease, stroke, and venous thromboembolism. Am J Epidemiol 2005;162:975-82. https://doi.org/10.1093/aje/kwi309
  15. Colwell AS, Reish RG, Kuter DJ, et al. Abdominal contouring procedures increase activity of the coagulation cascade. Ann Plast Surg 2012;69:129-33. https://doi.org/10.1097/SAP.0b013e318226b38b
  16. Raskob GE, Hirsh J. Controversies in timing of the first dose of anticoagulant prophylaxis against venous thromboembolism after major orthopedic surgery. Chest 2003;124:379S-385S. https://doi.org/10.1378/chest.124.6_suppl.379S
  17. Graca Neto L, Araujo LR, Rudy MR, et al. Intraabdominal pressure in abdominoplasty patients. Aesthetic Plast Surg 2006;30:655-8. https://doi.org/10.1007/s00266-004-5026-x
  18. Ivatury RR, Diebel L, Porter JM, et al. Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am 1997;77:783-800. https://doi.org/10.1016/S0039-6109(05)70584-3
  19. van der Beek ES, van der Molen AM, van Ramshorst B. Complications after body contouring surgery in post-bariatric patients: the importance of a stable weight close to normal. Obes Facts 2011;4:61-6. https://doi.org/10.1159/000324567
  20. Warner MA, Offord KP, Warner ME, et al. Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patients. Mayo Clin Proc 1989;64: 609-16. https://doi.org/10.1016/S0025-6196(12)65337-3
  21. Segreto F, Simone P, Piombino L, Persichetti P. Plastic surgery improves long-term weight control after bariatric surgery. Plast Reconstr Surg 2014;133:599e-600e.

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