Effect of Postoperative Aspirin on Outcomes in Microvascular Free Tissue Transfer Surgery

Lighthall, Jessyka G.; Cain, Rachel B.; Ghanem, Tamer; Wax, Mark K.

doi:10.1177/0194599812463320

Cited by 72 publications

(106 citation statements)

References 25 publications

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“…153 A recent retrospective analysis of 309 free flaps from the head and neck microvascular groups have suggested that postoperative anticoagulation with any anticoagulation (e.g., aspirin, lowmolecular-weight heparin, heparin drip) does not offer protective effects for microvascular thrombosis and increases complication rates (Level IV Evidence). 154 Selection of patients in treatment arms was not randomized and was unclear. The landmark multicenter prospective free flap study by Khouri et al discovered that only postoperative subcutaneous heparin had a significant preventative effect on flap thrombosis (Level I Evidence).…”

Section: Postoperative Protocols Anticoagulationmentioning

confidence: 99%

Evidence to Support Controversy in Microsurgery

Fan

Patel

Mardini

et al. 2015

Plastic and Reconstructive Surgery

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Microsurgery practice, including preoperative patient selection, intraoperative technique, and anesthetic considerations, varies from institution to institution and from surgeon to surgeon. Many surgeons' practices are driven by "conventional wisdom," which is handed down from mentors to fellows and residents. In this article, the authors explore the oxymoron that there is evidence to support controversy in microsurgery. Indeed, if there was convincing evidence to support varying microsurgery practices, there would be no controversy. The authors conducted a review with a focus on evidence-based medicine to support microsurgery practice.

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Section: Postoperative Protocols Anticoagulationmentioning

confidence: 99%

Evidence to Support Controversy in Microsurgery

Fan

Patel

Mardini

et al. 2015

Plastic and Reconstructive Surgery

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“…Two studies [15],[17] compared aspirin and heparin for the prevention of flap loss, and the ORs of the 2 studies were 1.688 and 2.087, respectively (Figure 2). There was heterogeneity in the combined OR of the 2 studies (Q = 0.052, I 2 = 0%, p = 0.819); therefore a fixed-effects model of analysis was used.…”

Section: Resultsmentioning

confidence: 99%

Effect of Heparin on Prevention of Flap Loss in Microsurgical Free Flap Transfer: A Meta-Analysis

et al. 2014

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The effectiveness of heparin for thromboprophylaxis during microvascular free flap transfer is uncertain. The purpose of this meta-analysis was to determine the effect of heparin on the prevention of flap loss in microsurgical free flap transfer.A search of PubMed, Cochrane databases, and Google Scholar using combinations of the search terms heparin, free flap, flap loss, free tissue transfer was conducted on March 15, 2013. Inclusion criteria were: 1) Prospective randomized trials. 2) Retrospective, non-randomized studies. 3) Patients received free tissue transfer. Flap loss rate was used to evaluate treatment efficacy. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated and compared between therapies. Four studies meet the criteria for analysis and were included. Two studiescompared aspirin and heparin, and the ORs of the 2 studies were 1.688 and 2.087. The combined OR of 2.003 (95% CI 0.976–4.109, p = 0.058) did not indicate any significant difference between heparin and aspirin therapies. Two studiescompared high and low doses of dalteparin/heparin therapies, and the ORs of the 2 studies were 4.691 and 11.00. The combined OR of 7.810 (95% CI 1.859–32.808, p = 0.005) revealed a significant difference indicating that high dose dalteparin or heparin therapy is associated with a greater flap loss rate than low dose therapy. Heparin and aspirin prophylaxis are associated with similar flap loss rates after free flap transfer, and high dose dalteparin or heparin therapy is associated with a greater flap loss rate than low dose therapy.

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“…Patients undergoing head and neck free flap reconstruction are often anticoagulated postoperatively. Anticoagulation is associated with postoperative hematoma formation, although almost always at a surgical site [8]. …”

Section: Discussionmentioning

confidence: 99%

Spontaneous Iliopsoas Hematoma following Microvascular Free Tissue Transfer

Markey

Alemi

Naunheim

et al. 2017

Case Reports in Otolaryngology

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Spontaneous hematoma within the iliopsoas muscle (SIH) is a rare complication most commonly seen in coagulopathic patients. Often, patients undergoing microvascular free tissue transfer are anticoagulated for anastomotic patency. Here we describe two cases of postoperative SIH following contralateral anterolateral thigh (ALT) free tissue transfer for reconstruction of oncologic head and neck defects. Both patients described hip pain after mobilization and had a corresponding acute blood loss anemia. Diagnosis of SIH was confirmed by CT and both patients were managed conservatively. Given that anticoagulation is a common practice following head and neck free tissue transfer, surgeons should be aware of this potential complication.

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Effect of Postoperative Aspirin on Outcomes in Microvascular Free Tissue Transfer Surgery

Cited by 72 publications

References 25 publications

Evidence to Support Controversy in Microsurgery

Evidence to Support Controversy in Microsurgery

Effect of Heparin on Prevention of Flap Loss in Microsurgical Free Flap Transfer: A Meta-Analysis

Spontaneous Iliopsoas Hematoma following Microvascular Free Tissue Transfer

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