Factor V Leiden (FVLeiden) mutation is the commonest type of inherited thrombophilia. Free tissue transfer is very rarely used in such patients due to concerns about microvascular thrombosis and flap failure. Even when rarely offered, the peri-operative antithrombotic regimen for such cases is widely varied and based of personal experiences and preference. These regimens usually include multiple pharmacologic agents but their real benefit is based merely on anecdotal evidence. On the other hand, the potential complications of such drugs are well established in literature. Deep Inferior Epigastric Perforator (DIEP) flap is the most widely used autologous breast reconstruction technique. Here, we report a case of successful free DIEP flap breast reconstruction in a lady with heterozygous FVLeiden mutation. We have described our approach to this patient, including the simple single drug anticoagulation regimen used as advised by the hematologists for venous thromboembolism (VTE) prophylaxis. We have compared our approach to that of others who have reported similar cases before. Our report shows that it is feasible to offer successful free tissue breast reconstruction to these patients by following meticulous surgical technique without the need of additional systemic antithrombotic agents over and above the simple regimen indicated for general VTE prophylaxis.
Key words: DIEP flap, thrombophilia, Factor V Leiden, thromboprophylaxis
|
