Heparin-induced thrombocytopenia syndrome as a cause of flap failure: a report of two cases.

BACKGROUND: Flap failure is a major complication in reconstructive plastic surgery. One of the most frequent etiologies of flap failure is venous thrombosis. However, infrequent causes also need to be explored, especially when faced with recurrent thrombosis. Heparin is frequently used in the prevention of venous thrombosis; however, the use of the medication itself may cause a serious thromboembolic state via an immune-related pathophysiological process. This adverse reaction to heparin may be life threatening. CASE PRESENTATION: We present two cases, one pedicled and one free flap, with venous congestion concomitant to heparin-induced thrombocytopenia syndrome, in conjunction with severe life-threatening sequelae. CONCLUSIONS: Heparin-induced thrombocytopenia syndrome can be the cause of postoperative venous congestion. It is necessary to be alert for this syndrome in the presence of recurrent unexplained venous thrombosis or thrombocytopenia in patients receiving anticoagulation therapy.

Intravenous regional anesthesia administered by the operating plastic surgeon: is it safe and efficient? Experience of a medical center.

BACKGROUND: Intravenous regional anesthesia (Bier's block) is an effective method of providing anesthesia for extremity surgery. This technique is most suitable for short-duration, less than 60-minute surgical procedures in distal extremities. Earlier studies recommended that intravenous regional anesthesia be performed by anesthesiologists who are familiar with the technique and fully trained to treat its complications. This study was conducted to demonstrate that intravenous regional anesthesia administered by the operating plastic surgeon is safe, efficient, and simple to perform. METHODS: A 5-year retrospective chart review (January of 2000 to December of 2004) was undertaken. The study included patients who underwent surgical procedures and were administered intravenous regional anesthesia by the surgeon. RESULTS: Four hundred forty-eight patients were included in the study, and 479 operations of 483 scheduled were completed under intravenous regional anesthesia performed by the operating surgeon. Intravenous regional anesthesia was efficient in 478 of 479 of the cases (99.8 percent). Tourniquet-related technical problems were noted in five of 483 cases (1 percent), resulting in cancellation of four operations, with no reported consequent anesthetic toxicity. Minor complications were reported in six of 479 of the cases (1.2. percent). No major complications occurred. CONCLUSIONS: Despite earlier worries about the safety of intravenous regional anesthesia if not administered by anesthesiologists, the authors found that intravenous regional anesthesia represents a safe and efficient technique of anesthesia for extremity surgery when performed carefully and appropriately by the operating surgeon. The authors suggest that plastic surgeons familiarize themselves with this technique, which is simple to perform. This could probably result in lower overall costs and greater autonomy for the surgeon.