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has been cited by the following article:

• TITLE: Thrombotic Occlusion of a Microvascular Anastomosis in a Resistance to Activated Protein C (APC) Patient with Incomplete Wound Healing after High Doses of Ascorbic Acid (Vitamin C)

  AUTHORS: Martijn P. J. Loonen, Bob De Frene, Bob Casaer

  KEYWORDS: Thrombotic Occlusion; Vitamin C; Activated Protein C

  JOURNAL NAME: Modern Plastic Surgery, Vol.2 No.3, July 20, 2012

  ABSTRACT: A 45-year-old woman underwent a delayed breast reconstruction with a free Deep Inferior Epigastric Perforator Flap (DIEP flap) with total flap failure on the fourth postoperative day. Hematological investigation to exclude thrombofilia revealed a resistance to activated protein C (APC) with a factor V Leiden heterozygous mutation. The postoperative course was further complicated by delayed wound healing probably due to ascorbic acid (Vitamin C) related cytotoxic activity to fibroblasts. The surgeon must be aware of the use of preoperative nutritional supplement administration among patients. Future cost-effectiveness analyses should be made to warrant preoperative thrombophilia screening to prevent free flap failures.