| Arnljots, Söderström and Svensson 1998[@255574] |
11 |
All 11 patients had hetero fVL (mutations not specified) |
Information not given |
Information not given |
1/11 flap failure due to thrombosis (TRAM flap lost on D3) |
All patients received 20–40 mg enoxaparin on evening before surgery, 80–100 IU heparin given as IV boluses at vascular reperfusion, 500 mL dextran given D2 and D4, after D5 given 20–40 mg enoxaparin until fully ambulant |
| Olsson and Hoijer 2005[@255572] |
1 |
Hetero fVL (mutation not specified) |
Mastectomy defect |
Free TRAM |
Intraoperative thrombosis; flap survived; DVT 2 months postop |
LMW heparin (20 mg) on day of operation and twice daily postop and for the remainder of hospital stay |
| Vekris et al 2007[@255576] |
1 |
Compound hetero fVL (G1691A and A4070G)
and homo MTHFR mutation (C677T) |
Traumatic defect L forearm |
1. R gracilis flap |
Postop venous thrombosis and DVT R lower extremity, flap failure |
Flap thrombus treated with IV heparin and oral warfarin |
| 2. L gracilis flap |
Intraoperative flap thrombosis and flap failure, postop PE |
|
| Davison, Kessler and Al-Attar 2009[@255570] |
2 |
1. Hetero fVL (R506Q),
elevated PAI-1, protein S deficiency, elevated factor VIII, elevated anytiphosphatidyl IgG and IgM antibodies, compound hetero MTHFR (C677T and A1298C) |
Ethmoid sinus fistula |
SIEP |
Intraoperative arterial thrombosis, flap failure |
Intraoperative tissue plasminogen activator flush and heparin drip |
| 2. Hetero fVL (R506Q), hetero PAI-1 gene mutation (4G/5G), protein S deficiency |
Bilateral mastectomy |
Immediate reconstruction, bilateral msTRAM |
Intraoperative thrombosis in both flaps, bilateral flap failure |
Intraoperative papaverine administration for revision to internal mammary arteries |
| Handschin et al 2010[@255575] |
1 |
Hetero fVL (G1691A) |
Mastectomy defect |
Free TRAM |
Intraoperative and postop thrombosis, flap failure |
Subcutaneous LMW heparin (dalteparin) 2 x 5000 IU/day prior to operation, postop aspirin 100 mg/day and IV heparin 10,000 IU/day for first two days; in the second operation, urokinase 100,000 IU was given into arterial side of flap, therapeutic
unfractionated heparin was started 4 hours postop in increasing doses |
| Khansa et al 2011[@255573] |
2 |
1. Hetero fVL (R506Q) |
R partial mastectomy defect |
DIEP |
Intraoperative and postop thrombosis, flap failure |
5000 IU subcutaneous heparin given preoperatively, intraoperatively, flap was irrigated with heparinised saline after initial vessel ligation and after both re anastomosis |
| 2. fVL (hetero or homo not specified, mutation not specified) |
L partial mastectomy defect |
SGAP |
Postop thrombosis, flap failure |
5000 IU subcutaneous heparin and aspirin given preoperatively, flap irrigated with heparinised saline |
| Wang T et al 2012[@255568] |
2 |
1. fVL mutation (hetero or homo not specified, mutation not specified) |
Mastectomy defect |
msTRAM |
No complications, flap viable |
Intraoperative heparin bolus 2000 IU, postop heparin drip at 250 IU/hr, aspirin 325 mg for 2 days postop |
| 2. fVL mutation (hetero or homo not specified, mutation not specified) |
Mastectomy defect |
msTRAM |
No complications, flap viable |
Subcutaneous heparin every 8 hours, aspirin 325 mg for 2 weeks at discharge; tamoxifen withheld 1 week pre and postop |
| Endara and Nahabedian 2013[@255577] |
1 |
Hetero fVL (mutation not specified), vW disease, factor VII deficiency, hetero MTHFR mutation (mutation not specified) |
Mastectomy defect |
DIEP |
No complications, flap viable |
IV heparin withheld due to bleeding risk, papaverine given intraoperatively for vasospasm, dextran IV for 48 hours postop, oral aspirin started D1 |
| DeFazio et al 2016[@255571] |
1 |
Hetero fVL (G1691A) |
Achilles defect |
ALT |
No complications, flap viable |
5000 IU heparin IV prior to pedicle division, local irrigation with 100 IU/mL heparinised saline prior to anastomosis; 5000 IU subcutaneous heparin every 8 hours postop, 325 mg aspirin for 2 weeks from D1; prophylactic enoxaparin for 2 weeks after discharge |