Successful penile reconstruction following prior arteriovenous loop thrombosis due to undiagnosed protein-S deficiency and exogenous testosterone

ABSTRACT

Flap failure from microvascular thrombotic occlusion is a rare but significant cause for unsuccessful reconstructive surgery. We encountered thrombosis of arteriovenous loop in a patient undergoing phallus reconstruction. Further investigations revealed underlying previously asymptomatic hypercoagulable state due to protein-S deficiency in addition to long-term exogenous testosterone administration. Role of thrombophilia testing, thrombogenic potential of testosterone and the need for therapeutic perioperative anti-coagulation in such situations are described here.

KEY WORDS

Microvascular thrombosis - testosterone - thrombophilia

• REFERENCES

• 1 Ashjian P, Chen CM, Pusic A, Disa JJ, Cordeiro PG, Mehrara BJ. The effect of postoperative anticoagulation on microvascular thrombosis. Ann Plast Surg 2007; 59: 36-9
• 2 Friedman T, O’Brien Coon D, Michaels VJ, Bontempo F, Young VL, Clavijo JA. et al. Hereditary coagulopathies: Practical diagnosis and management for the plastic surgeon. Plast Reconstr Surg 2010; 125: 1544-52
• 3 Bowman KG, Carty MJ. Flap complications and thrombophilia: An evidence-based model and cost analysis for preoperative screening. Eplasty 2011; 11: e32
• 4 Handschin AE, Guggenheim M, Calcagni M, Künzi W, Giovanoli P. Factor V Leiden mutation and thrombotic occlusion of microsurgical anastomosis after free TRAM flap. Clin Appl Thromb Hemost 2010; 16: 199-203
• 5 Salgarello M, Cervelli D, Barone-Adesi L. A massive arterial thrombosis of a free anterolateral thigh flap in a patient with antiphospholipid syndrome. Microsurgery 2008; 28: 447-51
• 6 Tchaikovski SN, Rosing J. Mechanisms of estrogen-induced venous thromboembolism. Thromb Res 2010; 126: 5-11
• 7 Freedman J, Glueck CJ, Prince M, Riaz R, Wang P. Testosterone, thrombophilia, thrombosis. Transl Res 2015; 165: 537-48
• 8 Liljeqvist S, Helldén A, Bergman U, Söderberg M. Pulmonary embolism associated with the use of anabolic steroids. Eur J Intern Med 2008; 19: 214-5
• 9 Glueck CJ, Goldenberg N, Budhani S, Lotner D, Abuchaibe C, Gowda M. et al. Thrombotic events after starting exogenous testosterone in men with previously undiagnosed familial thrombophilia. Transl Res 2011; 158: 225-34
• 10 Glueck CJ, Wang P. Testosterone therapy, thrombosis, thrombophilia, cardiovascular events. Metabolism 2014; 63: 989-94