Utility of Viscoelastic Tests to Predict Flap Thrombosis: A Systematic Review.

Autor:	Malapati H; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md., Hanwright PJ; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md., Tuffaha SH; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery. Global open [Plast Reconstr Surg Glob Open] 2021 Aug 12; Vol. 9 (8), pp. e3769. Date of Electronic Publication: 2021 Aug 12 (Print Publication: 2021).
DOI:	10.1097/GOX.0000000000003769
Abstrakt:	Background: Flap thrombosis is a rare but devastating complication in microsurgery. Preoperative identification of patients at increased risk for microvascular thrombosis remains challenging. Viscoelastic testing (VET) provides a comprehensive evaluation of the clotting process and can effectively identify hypercoagulability. However, the utility of VET in microvascular reconstruction remains unclear. Methods: A systematic review of the association between VET and pedicle thrombosis and free flap loss was performed in accordance with Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Identified studies were reviewed independently by two authors for pertinent data. Results: Six studies met inclusion criteria. Heterogenous study design and outcome reporting complicated direct comparisons and precluded a formal meta-analysis. Four studies found a statistically significant relationship between VET results and flap thrombosis or flap loss. The maximum clot strength and the fibrinogen-to-platelet ratio (FPR) were key viscoelastic parameters in these studies, both representing a measure of maximal clot strength. Specifically, an elevated FPR (>42%) generated a sensitivity and specificity for flap loss ranging from 57% to 75% and 60% to 82%, respectively. Notably, the negative predictive value for flap failure with a normal preoperative FPR was greater than 90% in all studies reporting a correlation. The remaining two studies reported no predictive value for VET with respect to flap failure or pedicle thrombosis. Conclusion: The results of this review suggest that VET, particularly parameters relating to clot strength, may help clinicians identify patients at risk for flap thrombosis. However, uncontrolled and heterogenous reporting limit definitive conclusions, and high-quality diagnostic studies are needed to better determine the clinical utility of viscoelastic testing for free flap patients. Competing Interests: Disclosure: The authors have no financial interest to declare in relation to the content of this article. (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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