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Low-molecular-weight heparin salvage in pedicled flap reconstruction in head and neck: a prospective cohort study
Published online by Cambridge University Press: 11 April 2024
Abstract
Objective
To determine if systemic administration of low-molecular-weight heparin impacts venous compromise in loco-regional flap reconstruction for head and neck subsites.
Methods
This prospective study was conducted on patients who had developed features of venous compromise of the flap. The case group received low-molecular-weight heparin (dalteparin).
Results
Of the 73 patients who developed venous congestion, low-molecular-weight heparin was administered in 47 patients. In the low-molecular-weight heparin subset, 23 patients had either reversal or non-progression of venous compromise (48.9 per cent). Of the patients who had no response to low-molecular-weight heparin rescue, complete necrosis was seen in 4 and partial flap necrosis was observed in 19. The corresponding numbers in the control group were 13 and 12, respectively (odds ratio 23.9, p = 0.002). Additionally, the low-molecular-weight heparin arm had a lower incidence of partial or complete flap necrosis (p = 0.002).
Conclusion
Low-molecular-weight heparin salvage, when instituted early, is likely to result in a significant reduction in flap-related morbidity.
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- Copyright
- Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED
Footnotes
Smriti Panda takes responsibility for the integrity of the content of the paper
This paper was presented in the ‘Most Outstanding Work’ section of the 2022 International Conference of the Korean Society for Head and Neck Oncology 24–25 September 2022, at Seoul, South Korea
References
Kanazawa, T, Sarukawa, S, Fukushima, H, Takeoda, S, Kusaka, G, Ichimura, K. Current reconstructive techniques following head and neck cancer resection using microvascular surgery. Ann Vasc Dis 2011;4:189–95CrossRefGoogle ScholarPubMed
Shah, JP, Haribhakti, V, Loree, TR, Sutaria, P. Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg 1990;160:352–5CrossRefGoogle ScholarPubMed
Akan, IM, Yildirim, S, Gideroğlu, K. Salvage of flaps with venous congestion. Ann Plast Surg 2001;46:456CrossRefGoogle ScholarPubMed
Talbot, SG, Pribaz, JJ. First aid for failing flaps. J Reconstr Microsurg 2010;26:513–15CrossRefGoogle ScholarPubMed
Pérez, M, Sancho, J, Ferrer, C, García, O, Barret, JP. Management of flap venous congestion: the role of heparin local subcutaneous injection. J Plast Reconstr Aesthet Surg 2014;67:48–55CrossRefGoogle ScholarPubMed
Pršić, A, Kiwanuka, E, Caterson, SA, Caterson, EJ. Anticoagulants and statins as pharmacological agents in free flap surgery: current rationale. Eplasty 2015;15:e51Google ScholarPubMed
Chien, W, Varvares, MA, Hadlock, T, Cheney, M, Deschler, DG. Effects of aspirin and low-dose heparin in head and neck reconstruction using microvascular free flaps. Laryngoscope 2005;115:973–6CrossRefGoogle ScholarPubMed
Numajiri, T, Sowa, Y, Nishino, K, Arai, A, Tsujikawa, T, Ikebuchi, K et al. Use of systemic low-dose unfractionated heparin in microvascular head and neck reconstruction: influence in free-flap outcomes. J Plast Surg Hand Surg 2016;50:135–41CrossRefGoogle ScholarPubMed
Khouri, RK, Cooley, BC, Kenna, DM, Edstrom, LE. Thrombosis of microvascular anastomoses in traumatized vessels: fibrin versus platelets. Plast Reconstr Surg 1990;86:110–17CrossRefGoogle ScholarPubMed
Savoie, FH, Cooley, BC, Gould, JS. Valuation of the effect of pharmacologic agents on crush-avulsion arterial injuries: a scanning electron microscopy study. Microsurgery 1991;12:292–300CrossRefGoogle Scholar
Bahl, V, Shuman, AG, Hu, HM, Jackson, CR, Pannucci, CJ, Alaniz, C et al. Chemoprophylaxis for venous thromboembolism in otolaryngology. JAMA Otolaryngol Head Neck Surg 2014;140:999–1005CrossRefGoogle ScholarPubMed
Pan, XL, Chen, GX, Shao, HW, Han, CM, Zhang, LP, Zhi, LZ. Effect of heparin on prevention of flap loss in microsurgical free flap transfer: a meta-analysis. PloS One 2014;9(4):e95111CrossRefGoogle ScholarPubMed
Blackburn, TK, Java, KR, Lowe, D, Brown, JS, Rogers, SN. Safety of a regimen for thromboprophylaxis in head and neck cancer microvascular reconstructive surgery: non-concurrent cohort study. Br J Oral Maxillofac Surg 2012;50:227–32CrossRefGoogle ScholarPubMed
Eley, KA, Parker, RJ, Watt-Smith, SR. Low molecular weight heparin in patients undergoing free tissue transfer following head and neck ablative surgery: review of efficacy and associated complications. Br J Oral Maxillofac Surg 2013;51:610–14CrossRefGoogle ScholarPubMed
Khouri, RK, Cooley, BC, Kunselman, AR, Landis, JR, Yeramian, P, Ingram, D et al. A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg 1998;102:711–21CrossRefGoogle ScholarPubMed
Glicksman, A, Ferder, M, Casale, P, Posner, J, Kim, R, Strauch, B. 1457 years of microsurgical experience. Plast Reconstr Surg 1997;100:355–63CrossRefGoogle ScholarPubMed
Caprini, JA. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism. Am J Surg 2010;199:S3–10.CrossRefGoogle ScholarPubMed
Kroll, SS, Miller, MJ, Reece, GP, Baldwin, BJ, Robb, GL, Bengtson, BP et al. Anticoagulants and hematomas in free flap surgery. Plast Reconstr Surg 1995;96:643–7CrossRefGoogle ScholarPubMed