Decrease of Thrombosis in Microsurgical Anastomoses: The Use of Intraoperative Pure Intraluminal Unfractionated Heparin

Abstract

Background Unfractionated heparin has anticoagulant properties by catalyzing antithrombin III, which inactivates coagulation enzymes. Used in microsurgery, it would prevent the occurrence of thrombosis during microsurgical anastomoses. The objective of this study was to evaluate the role of intraoperative irrigation of the vascular lumen with pure sodium heparin to prevent vascular thrombosis after end-to-end microsurgical anastomoses. Methods End-to-end anastomoses were performed on rats by 21 operators. Three surgical sites were studied (cervical, femoral, and rat tail). The first vessel was irrigated with physiological salt solution (0.9%) before, during, and before the end of the anastomosis. Whenever possible, the contralateral vessel was irrigated with pure unfractionated heparin 5,000 UI/mL. The primary endpoint was the occurrence of thrombosis 60 minutes after anastomosis. Results From November 2015 to April 2018, 247 anastomoses were performed on 229 arteries and 18 veins. One hundred twenty-five anastomoses were irrigated with physiological salt solution, 122 with pure unfractionated heparin. A 60-minute thrombosis was found on 31 anastomoses (25%) irrigated with physiological salt solution compared with 16 anastomoses (13%) irrigated with heparin, that is, a decrease in the thrombosis rate of 2.6 (p = 0.01). Conclusion The use of pure unfractionated heparin in intraoperative lumen irrigation during microsurgical end-to-end anastomoses reduces the rate of vascular 60-minute thrombosis compared with physiological salt solution irrigation. It is an effective intraoperative procedure for the prevention of microsurgical thrombosis.

The Influence of Topically Administered Heparin on Peripheral Microcirculation of the Skin: A Double-Blind, Randomized, Controlled Preliminary Study on 50 Healthy Subjects

“…[28][29][30] Ramelli et al showed that intraluminal application of heparin reduced the rate of thrombosis. 9 However, neither ASA nor the choice of thrombosis prophylaxis showed to prevent flap failure. Some studies even revealed a higher complication rate [31][32][33] since all systemic applied anticoagulatory substances have side effects, for example bleeding.…”

“…8 The intraluminal application of heparin has also shown to reduce the thrombosis rate of anastomoses in an animal study. 9 Pérez et al 10 reported that local subcutaneous injection of heparin to be an effective alternative in improving flap venous congestion. Topically administered heparin is used in the treatment of thrombophlebitis and for faster resorption of hematomas in sports medicine.…”

Evidence-Based Approaches to Anticoagulation in Reconstructive Microsurgery—A Systematic Literature Review

“…The primary endpoint was vascular 60 min thrombosis. The results showed a significant impact with a decrease in the thrombosis rate of 2.6 with heparin irrigation without increasing complications [72].…”

Moisturization of the Surgical Field during Cancer Resection Reduces Perioperative Complications in Reconstruction Surgery

“…3,4 In reconstruction after head and neck cancer resection, elderly patients and those who received preoperative irradiation tend to have more postoperative complications. 5,6 The use of heparin 7 or papaverine 8 during reconstruction has been reported to prevent intraoperative thrombus formation at the anastomotic site. In the present study, moisturization during cancer resection was found to significantly reduce intraoperative arterial thrombosis.…”