126. Free Tissue Transfer to the Lower Extremity in the Setting of Thrombocytosis and the Role of Intraoperative Antiplatelet Therapy: A Single Institution Retrospective Review

PURPOSE: In patients undergoing lower extremity (LE) free tissue transfer (FTT), preoperative thrombocytosis (PT) is associated with an increased risk of complications in select patient populations. We sought to assess the feasibility of performing LE FTT in atraumatic patients with PT, and whether antiplatelet (AP) therapy on the day of surgery (DOS) affects outcomes. METHODS: A retrospective review of patients with PT who underwent LE FTT between 2011-2022 was performed. Patients were categorized based on AP therapy on the DOS. Outcomes included transfusion requirements, postoperative flap-related complications (thrombosis, hematoma, return to the operating room), rates of flap success, limb salvage and ambulatory status. RESULTS: Of the 279 patients who underwent LE FTT, 65 (23.3%) had PT; of which, 32 (49.2%) received DOS AP therapy (“AP group”). Patients in the AP group were older (58.9 vs. 51.6 years, p=0.014), and had a greater representation of diabetes mellitus (87.5% vs. 57.6%, p=0.007) and calcified vessels (62.5% vs. 12.1%, p<0.0001). Average intraoperative and postoperative transfusion volumes were significantly higher in the AP group (p<0.05). Flap success rate was 96.9% (n=63). Rates of postoperative thrombosis were similar (9.4% vs. 6.1%, p=0.672), as was hematoma incidence (9.4% vs. 3.0%, p=0.287). At mean follow-up of 21.6 + 21.5 months, limb salvage and ambulatory rates were 75.4% (n=49) and 78.5% (n=51), respectively, and mortality rate was 7.7% (n=5). CONCLUSION: PT is not an absolute contraindication to LE FTT. DOS AP therapy may be protective in comorbid patients, but must be weighed against possible short-term bleeding, suggested by increased transfusion requirements.