MICROVASCULAR TISSUE TRANSFER IN A PREGNANT PATIENT

Pregnancy is a relative contraindication for elective surgery. The pri mary concerns are for the safety of the fetus and the mother. However, there are particular problems involving microvascular surgery due to the pregnancy-associated hypercoagulable state. The authors were prese nted with a 35-year woman, 20 weeks pregnant, with a degloved foot and ankle associated with an open distal tibia/fibula fracture (Gustilo I IIB). Salvage of her leg required a microvascular tissue transfer. Acc ordingly, a combined latis-simus dorsi-serratus anterior free flap was performed with a saphenous vein graft to the popliteal vessels. The p atient was hypercoagulable and there were extensive platelet clots. He r consumption of heparin was enormous. Postoperatively, she was treate d with intravenous dextran for 5 days and for 17 days with intravenous heparin. After discharge, she was placed on subcutaneous heparin unti l she delivered a healthy baby. The flap survived and her leg was salv aged. The hypercoagulable state of pregnancy, as well as thromboprophy laxis, are discussed.