Summary: Patients who sustain high-energy polytrauma are a unique population in that their mechanism of injury may induce multiorgan damage requiring immediate interventions such as splenectomy and bony fixation for mangled extremities. This results in the intersection of certain conditions, such as postsplenectomy thrombocytosis with the need for soft tissue reconstruction, often with free tissue transfer, for limb salvage after severe trauma to the lower extremity. However, there are no treatment guidelines in the management of postsplenectomy thrombocytosis in the setting of a lower extremity free flap reconstruction. We present a patient who had initial free tissue transfer to the lower extremity complicated by delayed microvascular thrombosis at postoperative day 4, during which time his platelet count exceeded more than 1,000,000/mm3. However, a successful second lower extremity free tissue transfer was achieved after platelet-reductive treatment with platelet apheresis during the perioperative period. Our patient went on to heal from his second free flap without further complications. Thus, thrombocytosis in the setting of free tissue transfer requires perioperative intervention to correct this hematologic condition. An innovative utilization of platelet apheresis may ensure the success of free tissue transfer by addressing the thrombocytosis in microsurgical patients after splenectomy.
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