Inferior vena cava filters and lower limb flap reconstructions

Background: This is the first ever study looking at the combination of inferior vena cava (IVC) filters and flap reconstruction in traumatic lower limb injuries. The use of IVC filters is increasing and they are now being used prophylactically in trauma patients who are at a high risk of developing thromboembolism disease. Although it has been postulated that IVC filters, through its positioning in the IVC, results in a higher incidence of venous congestion and possibly failure of lower limb flaps, the effect of IVC filters on lower limb flap reconstructions has not been addressed in the published works. The aim of this study was to determine whether IVC filters affect the outcome of lower limb flap reconstructions in the trauma patient. Methods: Retrospective case series analysis of consecutive patients at the Alfred Hospital (Melbourne, Australia) who had lower limb flap reconstruction(s) and IVC filter placement from 1 July 2001 to 22 March 2005 (44-month period). Results: Seventeen patients (12 men and 5 women) had 23 lower limb flap reconstructions (10 free, 13 local flaps) and IVC filter insertion. All 23 flaps survived with no flap failures. A gracilis muscle free flap developed venous congestion but survived with conservative management. Conclusions: In our series, IVC filters were not associated with poor outcomes of lower limb flap reconstructions. These findings are encouraging, and based on the evidence to date, the presence of IVC filters should not deter lower limb flap reconstructions in trauma patients. In particular, free flap surgery to traumatized lower limbs is not an issue with patients who have IVC filters.