Management of Venous Thromboembolism (VTE) Complication Following Limb Replantation: A Report of Two Cases and Literature Review.

Venous thromboembolism (VTE) frequently occurs as a perioperative complication following major soft tissue reconstruction. Deep vein thrombosis (DVT) and pulmonary embolism (PE) represent the prevalent forms of VTE. Most of the symptoms manifest in a subtle or asymptomatic manner, complicating accurate and timely diagnosis. Upon identification, patients require prompt and careful management as a delay in diagnosis has been associated with high mortality and morbidity. The management of VTE involves balancing adequate anticoagulation and the associated risk of bleeding. This paper presents two cases of open fracture accompanied by vascular injuries resulting from high-energy trauma. Surgical debridement, vascular repair, and limb replantation were performed promptly. Negative pressure wound therapy (NPWT) was adopted to optimize the wound bed before coverage with a perforator-free flap. To mitigate the risk of bleeding associated with NPWT, anticoagulation was implemented using dextran. PE and concomitant DVT were identified within three days following extensive reconstructive procedures. Low-molecular-weight heparin replaced dextran, resulting in the resolution of VTE events within one week. The clinical team's prompt response has averted more serious perioperative complications. It is essential for the surgical team to conduct thorough surgical planning, which includes assessing the risk of VTE, determining the duration and type of the surgery involved, and anticipating potential perioperative complications.