Venous thromboembolism after facelift surgery under local anesthesia: results of a multicenter survey.

BACKGROUND: Venous thromboembolism (VTE) is a serious complication of cosmetic surgery, and studies have suggested that the incidence is not insignificant in facelift surgery. Use of local anesthesia over general anesthesia and shorter operative times are probable contributing factors to lower VTE incidence. Because there have been no large-scale assessments of VTE in facelifts as such, we investigated VTE incidence and relevant factors in facelift surgeries performed under local anesthesia only. METHODS: We conducted a retrospective multicenter survey of facelift surgeons who utilize the American Society of Anesthesiologists level 1 oral anxiolysis and local diluted lidocaine anesthesia technique. Anonymous online surveys were sent to surgeons with questions regarding facelifts performed and VTE incidence over the previous 19 months. RESULTS: Seventy-seven surgeons (93 % response rate) completed the survey, with 74 eligible surgeons reporting at least one facelift. Respondents reported five VTE events, for an overall VTE incidence of 1 event in 5,844 surgeries. Surgeons who reported performing facelifts at high volumes (>500 facelifts in 19 months) had a significantly lower VTE incidence than lower-volume surgeons (p = 0.011). High-volume surgeons also reported a significantly lower average operative time (p = 0.016), but for surgeries that did or did not result in VTE, there was no significant difference between surgeon-reported average operative times. CONCLUSION: The low VTE incidence in this facelift series supports prior understanding that there is a low risk of VTE in surgery performed under local anesthesia and in surgery with shorter operative times. Limiting ancillary procedures to the face likely reduces operative time and likely also contributes to a lower VTE rate. The data further suggest that physicians performing facelifts more frequently tend to have shorter average operative times and overall lower VTE incidence. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The effect of tirofiban on microvascular thrombosis: crush model.

BACKGROUND: Microvascular anastomotic thrombosis is a significant clinical problem, particularly in crush and avulsion injuries. Platelet deposition plays a particularly important role in the initiation and propagation of microvascular thrombosis, whereas thrombin has little effect in the acute phase of thrombus formation. Nevertheless, heparin (a specific thrombin inhibitor) remains the most widely used microvascular irrigant. The purpose of this study was to evaluate tirofiban HCl (Aggrastat), a glycoprotein IIb/IIIa inhibitor, and its role in preventing postoperative thrombosis in a crush anastomosis model. METHODS: A crush injury model using the rat femoral artery was used. End-to-end microvascular repairs were performed. One milliliter of irrigant was used within the vessel lumen before placement of the last suture. The irrigant used was randomized into one of four groups: lactated Ringer's as a control, tirofiban (50 microg/ml), heparin (100 U/ml), and a combination of heparin (100 U/ml) and tirofiban (50 microg/ml). The vessels were reexamined 24 hours postoperatively and patency was assessed. A total of 62 vessels were used for the study. RESULTS: The patency rate was two of 20 (10 percent) for the control group, 13 of 22 (59 percent) for the tirofiban group, one of 10 (20 percent) for the heparin group, and eight of 10 (80 percent) for the heparin plus tirofiban group. This study demonstrates a statistically significant improvement in patency with tirofiban irrigation in a crush anastomosis rat model when compared with saline or heparin alone. CONCLUSIONS: Clinically, tirofiban may have utility as a potent anticoagulant and is potentially useful in microvascular injuries that have a significant crush/avulsion component.