Thromboembolism risk and tummy tucks

There’s a good review article on the risk of blood clotting problems known as “VTE’s” and their relationship to abdominoplasty surgery in this months issue of Plastic and Reconstructive Surgery. VTE is the abbreviation for venous thrombo-embolism, and it includes such problems as deep vein thrombosis of the leg and pulmonary embolism.Although this topic may sound obscure, pulmonary embolism can be fatal, and it can sneak up and strike suddenly after major surgery, without warning symptoms. My friend, Dr. Paul Vanek, once described VTE’s as a “scud missile striking randomly in the middle of the night” – and that’s a good way to think about it. So, anything we can learn to understand and prevent this problem better is really very important.

The authors reviewed the plastic surgery literature on VTE’s, and their analysis revealed some findings that should make surgeons sit up and take notice.

In particular:

Risk of VTE with standard tummy tuck: 0.34% (= 1 / 300)

Risk of VTE when tummy tuck is combined with an intra-abdominal procedure (e.g. hysterectomy) 2.17% = 6 x risk

Risk of VTE when tummy tuck is combined with lower body lift (circumferential tummy tuck) 3.40% = 10 x risk.

Both of these findings were highly statistically significant.

Of course, wise surgeons do everything possible to prevent this problem. Using pneumatic compression leggings, which massage the calf area, keeping blood moving during surgery helps. Giving Lovenox, the medication which treats blood clots, helps significantly. And getting people moving as soon as possible after surgery helps too. But the risk of developing a VTE is still not eliminated.

So, what can we learn from this paper?

Personally, I think surgeons should give up doing the procedures that are high risk for these complications, until a proven strategy to prevent these potentially life-threatening problems can be developed and tested.

That mean no “circumferential” tummy tucks, and not doing tummy tucks at the same time as other operations inside the abdomen.

Just my two cents.

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