游离皮瓣手术后纤维蛋白原反应不足与出血并发症有关

J. Kolbenschlag, Y. Diehm, A. Daigeler, David Kampa, S. Fischer, N. Kapalschinski, O. Goertz, M. Lehnhardt
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引用次数: 2

摘要

背景:微血管组织移植已成为器械重建中一种安全可靠的工具,成功率高。然而,游离组织移植后凝血的变化及其对发病率的潜在影响知之甚少。方法:对139例手术前、术后即刻、术后1-3、8-11天进行游离组织移植的患者进行纤维蛋白原浓度、血小板计数等指标的测定和评估。对于因出血或微血管血栓形成而进行紧急翻修的患者,在再次探查前直接抽取血样。结果:未行手术翻修的患者和微血管蒂血栓形成的患者,术后早期和晚期窗口期纤维蛋白原浓度和血小板计数均明显升高。发生出血需要再次探查的患者显示纤维蛋白原水平增加不足,导致浓度明显低于其他两组。两组间血小板计数和PTT无显著差异。结论:游离皮瓣手术可引起急性和亚急性凝血功能改变,与其他大手术和重伤相当。这导致术后血小板计数和纤维蛋白原增加。发生出血需要再次手术探查的患者纤维蛋白原增加不足,导致纤维蛋白原水平明显降低。因此,监测和纠正纤维蛋白原水平可能有助于预防或治疗游离皮瓣手术后出血并发症。
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Insufficient fibrinogen response following free flap surgery is associated with bleeding complications
Background: Microvascular tissue transfer has become a safe and reliable tool in the reconstructive armamentarium, yielding high success rates. However, little is known about the changes in coagulation after free tissue transfer and their potential impact on morbidity. Methods: Fibrinogen concentration and platelet count among other values were available and assessed in 139 undergoing free tissue transfer before, immediately after, and 1–3 as well as 8–11 days after surgery. In patients undergoing urgent revision for either bleeding or microvascular thrombosis, blood samples were drawn directly before re-exploration. Results: In the patients without any surgical revision and in those with thrombosis of the microvascular pedicle, both fibrinogen concentration and platelet count increased significantly during the early and late post-operative window. Patients that developed bleeding necessitating re-exploration showed an inadequate increase in fibrinogen levels, resulting in significantly lower concentrations compared to the other two groups. There were no significant differences in platelet count or PTT between these groups. Conclusion: Free flap surgery induces acute and subacute changes in coagulation, comparable to other major surgeries and severe injuries. This leads to an increase in platelet count and fibrinogen over the post-operative course. Patients that developed bleeding requiring surgical re-exploration showed an insufficient increase in fibrinogen, resulting in significantly lower fibrinogen levels. Therefore, monitoring and correction of fibrinogen levels might aid in preventing or treating bleeding complications following free flap surgery.
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