Factor VIII-Related Free Flap Failure: A Case Report

Factor VIII所致之游離皮瓣壞死－案例報告

陳柵君(Cha-Chun Chen) ； 林煌基(Hwang-Chi Lin)

《臺灣整形外科醫學會雜誌》 19卷3期 (2010/09) Pp. 267-273

https://doi.org/10.7096/TJTSPS.201009.0267

摘要

背景：
游離皮瓣在重建手術上有相當高的成功率。近來在游離皮瓣手術失敗的探討已經由技術的討論的層面轉為凝血因子異常的可能性。這篇文真討論了一個因為過多factor VIII導致之游離皮瓣手術失敗。
目的及目標：
關於elevated factor VIII所致游離皮瓣手術失敗之案例報告。
材料及方法：
這個52歲男性因為車禍導致左腳皮膚缺損併跟骨外露，先後使用了游離骨薄肌及游離闊背肌皮瓣作重建，但是手術皆因爲皮瓣動靜脈栓塞而失敗。這個病人最後因傷口因素而改用植皮手術。這篇文章討論了這個病人的整個治療過程。
結果：
此游離皮瓣失敗主要是因爲過多factor VIII。雖然使用了low molecular weight heparin 和aspirin作治療，但是都無效。
結論：
Excess Factor VIII是靜脈栓塞疾病的常見原因，但是在皮瓣手術失敗的相慣性方面，鮮少被提及。在執行皮皮瓣手術方面，除了技巧方面，hypercoagulability也是需要特別注意。在這個case report，我們同時也討論了factor VIII的etiology，臨床表現和診斷，以及可能的治療方法。

並列摘要

Background:
Free vascularized tissue transfer is a well-established procedure in reconstructive surgery with high success rates. Nevertheless, issues related to coagulopathy-related free flap failure and clotting factors have been reported in the recent literature. In this report, we present a case with two free flap failures for elevated Factor VIII.
Aim and Objectivites:
We evaluated all factors for possible free flap failure. In the case with two free flap failure, we examined all possible factors for it. Elevation of Factor VIII in the operation was noted but it decreased several months later. Tracing all possible causes for excess Factor VIII, we made the conclusion that this free flap failure was closely related to trauma-induced elevation of Factor VIII.
Materials and Methods:
The patient presented a skin defect of the foot with exposure of calcaneous bone. Free gracilis muscle flap was performed in the first reconstruction suergery, and free latissimus dorsi muscle flap was used for the second. Both free flaps failed. Finally, this patient received skin graft for wound coverage.
Resultes:
Elevated factor VIII due to trauma has been detected here. In this case, we used low molecular weight heparin and aspirin to salvage the flap but in vain.
Conclusion:
While elevated Factor VIII has been a common cause of venous thromboembolism disease, little attention has been given to its relationship with free flap failure as arterial thrombosis. If there is no question of technique error, surgeons need to devote more attention to the occurrence of free flap failure with the possibility of hypercoagulability. In this case report, we focus on the rare etiology, clinical presentation, diagnosis, and possible methods for treatment.

並列關鍵字

Excess Factor VIII ； free flap failure ； microvascular failure