Relationship Between Preoperative Coagulation Parameters and Risk of Flap Pedicle Thrombosis Following Free Flap Breast Reconstruction.

Authors

Liwen Zhu, Boyang Xu, Wenyue Liu, Shangshan Li, Zhaohan Chen, Hao Dong, Siyu Hou, Xiaomu Ma, Ao Fu, Chunjun Liu

Published in

Microsurgery. Volume 46. Issue 6. Pages e70275.

Abstract

Flap pedicle thrombosis is a frequent cause of flap compromise, which is a major complication following free flap breast reconstruction. This study aims to investigate the relationship between preoperative coagulation parameters and the risk of postoperative flap pedicle thrombosis, providing guidance for preoperative assessment and perioperative management.
A retrospective analysis was conducted on all patients who underwent free flap breast reconstruction at our institution between January 2021 and August 2025. Patient demographics, surgical details, preoperative coagulation test results (including prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin time, and D-dimer) and outcomes were recorded. Patients were categorized according to their preoperative coagulation test results. Demographics, surgical information, and incidence of flap pedicle thrombosis were compared between groups. Furthermore, patients were divided according to the occurrence of flap pedicle thrombosis. Preoperative coagulation parameters were compared between the two groups, and a multivariate logistic regression was performed to identify potential risk factors.
A total of 154 patients (160 breasts) were included. Fifty-two breasts (32.5%) were categorized to the asymptomatic hypercoagulable group, and 108 breasts (67.5%) to the non-hypercoagulable group. Postoperative flap pedicle thrombosis occurred in nine breasts (5.6%), including two arterial thromboses and seven venous thromboses. No significant difference in postoperative flap pedicle thrombosis was observed between the two groups (9.6% vs. 3.7%, p = 0.152). Multivariate logistic regression indicated that immediate flap breast reconstruction might be an independent risk factor (p = 0.028).
This study suggested no significant association between preoperative coagulation parameters (including PT, APTT, FIB, TT, and D-dimer) and flap pedicle thrombosis following free flap breast reconstruction.

PMID:
42554436
Bibliographic data and abstract were imported from PubMed on 05 Aug 2026.

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