Venous thromboembolism in plastic surgery: incidence, current practice and recommendations.

Venous thromboembolic events (VTEs) are an important concern due to their frequently asymptomatic presentation and significant morbidity and/or mortality. The true incidence of this disease process is unknown as (i) screening procedures and (ii) prophylaxis protocols are frequently lacking in this patient population. The purpose of this study was to identify published thromboprophylactic recommendations established in the plastic surgery literature and to provide a review on thromboembolism and current methods of prophylaxis. A systematic evaluation of all published guidelines for thromboembolism prophylaxis in plastic surgery was conducted. We report on 24 studies in favour of, and three studies against, mechanical and/or pharmacological prophylaxis. Thromboprophylactic recommendations were published by a small randomised trial (grade B, level 2), six retrospective studies (grade C, level IV), two literature reviews (grade C, level V), two surveys (grade C, level V), three narrative reviews (Continuing Medical Education) (grade C, level V) and 10 expert recommendations (grade C, level V). The three publications against prophylaxis were composed of a retrospective study (grade C, level IV) and two case series with no control group (grade C, level V). There is a significant paucity of category A or B evidence favouring thromboprophylaxis in the plastic surgery patient population. There is a need for further research in established thromboprophylaxis guidelines in plastic and reconstructive surgery.