VONWILLEBRAND-DISEASE AND PLASTIC-SURGERY

Von Willebrand's disease (VWD) is the most commonly inherited coagulop athy. In a group of 1,000 plastic surgery patients, 8 or 9 individuals are affected by this disease, making basic knowledge of VWD and its m anagement imperative. In this investigation, 1,000 plastic surgery pat ients were studied for details of their clinical evaluation, history o f bleeding and bruising, and excessive bleeding during or after surger y. If the patient reported a history of easy bleeding or bruising, in addition to routine coagulation studies such as PT, PTT, and platelet count, the bleeding time was measured. When the index of suspicion dic tated, more extensive coagulation studies, such as factor VIII assay, were conducted. This resulted in the detection of VWD in 9 patients (8 female and 1 male). All patients had a positive history of easy bleed ing or bruising. Six of the 9 patients had a bleeding time greater tha n 6 minutes. Seven patients were diagnosed to have VWD type I, 1 had t ype II-a, and 1 suffered from type II-b disease. Perioperative bleedin g was controlled in all patients in this study with the administration of 0.3 mu g/kg of body weight (usually a total dose of 20 mu g) of 1- deamino-8-D-argininevasopressin intravenously every 12 hours for the f irst 24 hours. Two patients with type II VWD required fresh frozen pla sma and cryoprecipitate 1 week subsequent to surgery to control late b leeding.