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

Tremblay DM, Harris PG, Gagnon AR, Cordoba C, Brutus JP, Nikolis A

Division of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, 1560 Sherbrooke Street E, G3132, Montréal, Québec, Canada H2L 4M1.

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.

Published 10 December 2007 in J Plast Reconstr Aesthet Surg, 61(1): 78-83.
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