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Thromboembolic prophylaxis in plastic surgery D. G. Dujon, Depurtnmt

L. A. Chatzis

:

an appraisal

and N. B. Hart

qf’Plustic, Swger~~, Kirzgston Gerwral Hospital,

Hull

SUMM,A R Y. A survey by questionnaire was conducted amongst consultant plastic surgeons in the UK : 54 replies were received (44 % response rate). Three consultants (5.5 %) never used any form of DVT prophylaxis. The other 51 (94 %) used some form of prophylaxis in at-risk patients. The methods used were found to be diverse. Ten respondents belonged to units with fixed policies for prophylaxis. A controlled trial is suggested to provide statistical evidence of the need for thromboembolic prophylaxis among plastic surgical patients. We believe there is a need for units to develop fixed protocols for the prevention of thromboembolism in at-risk patients.

The incidence of Deep Vein Thrombosis (DVT) in general surgical patients when no prophylaxis is used has been found by randomised controlled trials to be 17 % (Colditz rt crl., 1986). Very little attention has been given to the incidence of DVT in plastic and reconstructive surgical patients. This poses two questions : 1. Is DVT a potential problem in this group patients‘? 3. What is the most effective and efficient method prophylaxis’?

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As a preliminary to answering these questions a survey was done among Plastic and Reconstructive Surgery Consultants in the British Isles.

Method A questionnaire was designed in three parts. Part One was aimed at determining the methods used by individual consultants for thromboembolic prophylaxis. These were related to specific risk factors and the nature of the operation to be performed. Part Two of the questionnaire sought data on the incidence of DVT and pulmonary embolism in the respondents’ practice over the preceding I? months. The third part asked whether the respondent had a personal policy for DVT prophylaxis and if not, whether it was a part of a fixed unit policy. A covering letter accompanying the questionnaire was sent with a self-addressed return envelope to all Consultant members of the British Association of Plastic Surgeons in the British Isles. Non-respondents were not re-circulated.

Results Fifty-four completed questionnaires were returned, a response rate of 44 O/O. Three Consultant Plastic Surgeons (5.5 9/o) never

used any form of prophylaxis against deep vein thrombosis. A total of 94% of respondents used some form of prophylaxis in at-risk patients. As can be seen from Table 1. the choice of prophylactic method varied widely. In addition to the methods seen in Table I. two consultants used low dose Aspirin in selected patients. Warfarin was used by three consultants as an alternative method of prophylaxis. Excluding the three consultants not using any form of prophylaxis, age was not considered to be a significant selection criterion by 92 O/o.The remaining 8% excluded patients less than 40 years of age from routine prophylaxis unless thought to be at high risk (Table 3). Thirty-four consultants (63 %) altered the method of prophylaxis used depending on the nature of operation performed. A total of 38 cases of DVT were reported by 54 consultants as occurring over the past I? months. Four of these occurred despite prophylaxis (3 subcutaneous heparin. I compression stockings). Eighteen cases of pulmonary emboli were reported. 17 among the 38 DVT patients and one without previously documented thrombosis. Three of the 18 cases were on subcutaneous heparin when pulmonary embolus was diagnosed. Twenty-three consultant plastic surgeons had a fixed personal policy for DVT prophylaxis. Only ten were members of units with a fixed unit policy.

Discussion Deep vein thrombosis (DVT) and pulmonary cmbolism are clinical problems confronting surgeons of all disciplines. It has previously been suggested that the incidence of DVT’s in plastic surgical patients is lower than that found in general surgery (Hale Enderby et ~1.. 1976). Of the 38 cases of DVT reported in our survey only 4 had some form of prophylaxis. We believe that more widespread use of prophylactic

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Thromboembolic prophylaxis in plastic surgery: an appraisal.

A survey by questionnaire was conducted amongst consultant plastic surgeons in the UK: 54 replies were received (44% response rate). Three consultants...
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