Incidence and Risk Factors of Pulmonary Thromboembolism in Pedicled TRAM Breast Reconstruction.

Lee, Sang Hyuk; Lee, Taik Jong; Eom, Jin Sup; Son, Byung Ho; Ahn, Sei Hyun; Lee, Sang Do

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2006;33(2):193-197.
Published online March 1, 2006.

Incidence and Risk Factors of Pulmonary Thromboembolism in Pedicled TRAM Breast Reconstruction.

Sang Hyuk Lee, Taik Jong Lee, Jin Sup Eom, Byung Ho Son, Sei Hyun Ahn, Sang Do Lee

¹Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. tjlee@amc.seoul.kr
²Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
³Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

Pulmonary thromboembolism is often clinically silent and difficult to diagnose, and can be fatal to patients with belated treatment. This complication is seen in patients who underwent TRAM breast reconstruction. Multiple factors are involved in this disease such as the presence of malignancy itself, major surgery and therapy-related interventions. TRAM surgery is a lengthy procedure involving mastectomy, flap surgery and abdominoplasty. The purpose of this study is to evaluate the incidence and the correlation between presurgical risk factors(BMI and age) of symptomatic pulmonary thromboembolism after TRAM surgery and the incidence. From July 2001 to March 2005 a total of 384 pedicled TRAM reconstruction of breast was performed in 382 patients at Asan Medical Center. The average of Body mass index was 21.9kg/m(2) and mean age of the patients was 37.9 years old. We diagnosed symptomatic pulmonary thromboembolism using ventilation/perfusion lung scan and pulmonary embolism computed tomography. Incidence of in-hospital symptomatic pulmonary thromboembolism was 1.3%. BMI and age showed no significant statistical relationship to pulmonary thromboembolism. But the incidence of symptomatic pulmonary thromboembolism in obese patients (BMI>25) was 3.75%. According to the guideline of the 7th American College of Chest Physicians Consensus Conference on Antithrombotic and Thrombolytic Therapy, the incidence of 3.75% was classified as high risk group. The prevention of pulmonary thromboembolism should be considered in cases of obese patients with low molecular weight heparin(BMI>25).

Keywords: TRAM flap; Breast reconstruction; Pulmonary thromboembolism

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