Anticoagulants and Hematomas in Free Flap Surgery

Kroll, Stephen S.; Miller, Michael J.; Reece, Gregory P.; Baldwin, Bonnie J.; Robb, Geoffrey L.; Bengtson, Bradley P.; Phillips, Martin D.; Kim, Daniel; Schusterman, Mark A.

doi:10.1097/00006534-199509000-00017

Cited by 113 publications

(146 citation statements)

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“…Subcutaneous postoperative heparin has been shown to lower postoperative thrombosis rates (15), and there is some support for the use of postoperative acetylsalicylic acid (16). The postoperative hematoma rate of 2% in this series of patients suggests that the above regimen was relatively safe and compares favourably with other series (17,18).…”

Section: Postoperative Regimensupporting

confidence: 68%

A review of 100 consecutive free flaps

Classen¹

1999

CAN J PLAST SURG

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T his study analyzes the first 100 consecutive free flaps performed by the author. Data were collected prospectively in a microsurgical data base as part of an ongoing review of the microsurgical experience of all patients undergoing free flap reconstructions The data were reviewed in a retrospective fashion. The review comprised 100 consecutive free flaps performed between January 1994 and February 1999 in 90 patients. Nine patients had two free flaps transferred to either bilateral extremity wounds, or complex facial or hand wounds. One patient had a second free flap performed to the same wound after failure of the first free flap. There were 58 men and 32 women. The age range was from eight to 80 years with an average age of 37 years. Ten patients were older than 65 years of age. RESULTS IndicationsThe indications for free flap transfer are outlined in Table 1. The vast majority (82%) of free flaps were performed for wounds related to trauma. This includes both acute and chronic traumatic wounds. The majority of these free flaps were to provide soft tissue coverage. The etiology of the traumatic wounds is indicated in Table 2. The majority of the wounds were related to motor vehicle accidents. Donor sitesA muscle free flap was used in 60% of the cases. The latissimus dorsi muscle and rectus abdominis muscle free flaps accounted for 58% of all muscle free flaps. A fasciocutaneous free flap was performed in 34% of cases. The scapular free flap and lateral arm free flap accounted for 76% of all fasciocutaneous free flaps. A complete breakdown of donor site flaps is outlined in Table 3. Recipient sitesThe majority of recipient sites (67%) were located in the lower extremity. Seventeen per cent of recipient sites were located in the head and neck region. Thirteen per cent of recipient sites were in the upper extremity or hand region. Table 4 summarizes the recipient site locations, free flaps transferred and the outcome. Recipient VesselsArterial anastomoses were performed with an end-to-side technique in 62% of cases or as an end-to-end technique in 38% of cases. The type of arterial anastomosis performed generally depended on the recipient site. Seventy-one per cent of lower extremity arterial anastomoses were performed with an end-to-side technique. Ninety-two per cent of upper

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Section: Postoperative Regimensupporting

confidence: 68%

A review of 100 consecutive free flaps

Classen¹

1999

CAN J PLAST SURG

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“…This poses a major threat to the tissue due to the ischemia reperfusion injury which can ultimately result in partial or total flap loss. 5 Prevention of thrombosis at the microvascular anastomosis of the free flap has been a concern for the microvascular surgeon since the earliest days of free tissue transfer 12 . Microvascular thrombosis has an alterable etiology for failure, addressing Virchow's triad of stasis, hypercoagulability, and vessel injury.…”

Section: Discussionmentioning

confidence: 99%

“…Significant medical co-morbidities, such as diabetes, hyper-coagulable disorders and alcohol withdrawal may result in an increased risk of flap failure. 9 No studies have demonstrated that anticoagulant will improve the patency rate of technically well performed microvascular anastomosis nevertheless failure of microvascular flap is always associated with microvascular thrombosis there may be subset of patients who may be benefited from the anticoagulant therapy 12 . Vascular occlusion (thrombosis) remains the primary reason for flap loss, with venous thrombosis being more common than arterial occlusion.…”

Section: Discussionmentioning

confidence: 99%

Role of heparin in microvascular free flap surgery in head and neck reconstruction

et al. 2015

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“…In a study from 1994, Kroll evaluated 517 free tissue transfers 17 . It was shown that the relationship between the use of anticoagulants and prevention of flap loss or prevention of thrombosis could not be established.…”

Section: No Evidence Of Efficacymentioning

confidence: 99%