Lower-extremity Deep Vein Thrombosis after Plastic Surgery: Clinical Characteristics and Outcomes in a Retrospective Case Series.

BACKGROUND

Deep vein thrombosis (DVT) is a significant complication in plastic surgery, particularly affecting the lower extremities. Understanding the associated characteristics can aid in developing effective prevention strategies.

METHODS

We conducted a retrospective, quality improvement-oriented case series of 5 ultrasound-confirmed symptomatic postoperative lower-extremity DVT events after plastic surgery under general anesthesia at a single institution (January 2020-May 2024). Among 39,055 general anesthesia procedures during the study period, de-identified records were reviewed for patient and procedural characteristics, prophylaxis and mobility pathways, duplex ultrasonography confirmation, management, and short-term outcomes. No non-DVT comparator cohort was extracted; analyses were descriptive and not intended for risk-factor inference. One patient with postoperative chest/back pain and transfer for suspected pulmonary embolism without in-hospital lower-extremity DVT confirmation was excluded from the final case series.

RESULTS

The 5 included cases were clinically heterogeneous and involved complex perioperative settings, including post-massive weight loss body contouring, craniofacial reconstruction with implant use, neurosurgical-related reconstruction, extensive head and neck lesion surgery, and posttraumatic facial reconstruction. All DVTs were confirmed by duplex Doppler ultrasonography, with thrombi involving the posterior tibial, peroneal, or calf muscular veins. Several cases involved prolonged procedures, reoperation for postoperative hematoma, or delayed mobilization. Postoperative anticoagulation was administered in most cases, whereas postoperative mechanical prophylaxis was not consistently documented.

CONCLUSIONS

In a very low-frequency setting, this series highlights potentially actionable prevention gaps-especially postoperative mechanical prophylaxis and mobility disruptions-rather than establishing causal risk factors.