Thromboprophylaxis in Intermediate and Major Plastic Surgery Procedures: A Narrative Review and Proposal of the TROMBO-PLAST Integrated Decision-Making Model.

Venous thromboembolism (VTE) is a leading cause of preventable perioperative morbidity and mortality in plastic surgery. However, its prevention demonstrates considerable variation in clinical practice, ranging from under-prophylaxis driven by concerns about hematoma formation to routine over-prophylaxis based solely on numerical risk scores. This narrative review critically examines the available tools for thrombotic and bleeding risk stratification in intermediate and major plastic surgery procedures and proposes an integrated decision-making model tailored to the specialty. A literature search was conducted in PubMed/MEDLINE, Cochrane Library, Embase, and SciELO, with priority given to publications from 2020 to 2026, complemented by selected landmark references. The Caprini score remains the most extensively validated risk stratification tool; however, it is insufficient when used in isolation. Integration with bleeding risk assessment, recognition of specialty-specific risk factors (including large-volume liposuction, abdominoplasty, gluteal fat grafting, post-bariatric body contouring, microsurgical flaps, and combined procedures), universal mechanical prophylaxis measures, appropriate timing of low-molecular-weight heparin administration, and dynamic postoperative reassessment can facilitate safer clinical decision-making. Thromboprophylaxis in plastic surgery requires the integration of thrombotic risk, bleeding risk, procedural context, and postoperative reassessment. The TROMBO-PLAST model is proposed as a practical framework to support this clinical reasoning while preserving individualized clinical judgment.