Efficacy of the postoperative management after microsurgical free tissue transfer

Sigaux, N.; Philouze, Pierre; Boucher, F.; Jacquemart, Mathieu; Frobert, P.; Breton, P.

doi:10.1016/j.jormas.2017.03.007

Cited by 17 publications

(15 citation statements)

References 28 publications

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“…Although blood transfusions have not been associated with free flap failure, there is concern that more than three blood transfusions after free tissue transfer increases risk of death and is associated with higher wound infection rates . In addition, blood transfusions are associated with higher incidence of medical complications and higher risk of unplanned readmission …”

Section: Discussionmentioning

confidence: 99%

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Controversies in free tissue transfer for head and neck cancer: A review of the literature

et al. 2019

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Background Microvascular free tissue transfer provides superior functional outcomes when reconstructing head and neck cancer defects. Careful patient selection and surgical planning is necessary to ensure success, as many preoperative, intraoperative, and postoperative patient and technical factors may affect outcome. Aims To provide a concise, yet thorough, review of the current literature regarding free flap patient selection and management for the patient with head and neck. Materials and Methods PubMed and Cochrane databases were queried for publications pertaining to free tissue transfer management and outcomes. Results Malnutrition and tobacco use are modifiable patient factors that negatively impact surgical outcomes. The use of postoperative antiplatelet medications and perioperative antibiotics for greater than 24 hours have not been shown to improve outcomes, although the use of clindamycin alone has been shown to have a higher risk of flap failure. Liberal blood transfusion should be avoided due to higher risk of wound infection and medical complications. Discussion There is a wide range of beliefs regarding proper management of patients undergoing free tissue transfer. While there is some data to support these practices, much of the data is conflicting and common practices are often continued out of habit or dogma. Conclusion Free flap reconstruction remains a highly successful surgery overall despite as many different approaches to patient care as there are free flap surgeons. Close patient monitoring remains a cornerstone of surgical success.

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Section: Discussionmentioning

confidence: 99%

“…44 In addition, blood transfusions are associated with higher incidence of medical complications and higher risk of unplanned readmission. [45][46][47]…”

Section: Blood Transfusionsmentioning

confidence: 99%

Controversies in free tissue transfer for head and neck cancer: A review of the literature

et al. 2019

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“…Several studies 53,56,60,61 have demonstrated the increased risk of complications with post-operative agents. Current evidence does not show increased flap viability with routine use of post-operative agents compared to no anti-thrombotic agents.…”

Section: Post-operative Managementmentioning

confidence: 99%

Multidisciplinary Practice Variations of Anti-Thrombotic Strategies for Free Tissue Transfers

et al. 2021

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Background: Venous thrombosis, the leading cause of free flap failure, may have devastating consequences. Many anti-thrombotic agents and protocols have been described for prophylaxis and treatment of venous thrombosis in free flaps. Methods: National surveys were distributed to microsurgeons (of both Plastics and ENT training) and hematology and thrombosis specialists. Data were collected on routine screening practices, perceived risk factors for flap failure, and pre-, intra-, and post-operative anti-thrombotic strategies. Results: There were 722 surveys distributed with 132 (18%) respondents, consisting of 102 surgeons and 30 hematologists. Sixty-five surgeons and 9 hematologists routinely performed or managed patients with free flaps. The top 3 perceived risk factors for flap failure according to surgeons were medical co-morbidities, past arterial thrombosis, and thrombophilia. Hematologists, however, reported diabetes, smoking, and medical co-morbidities as the most important risk factors. Fifty-four percent of physicians routinely used unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) as a preoperative agent. Surgeons routinely flushed the flap with heparin (37%), used UFH IV (6%), or both (8%) intra-operatively. Surgeons used a range of post-operative agents such as UFH, LMWH, aspirin, and dextran while hematologists preferred LMWH. There was variation of management strategies if flap thrombosis occurred. Different strategies consisted of changing recipient vessels, UFH IV, flushing the flap, adding post-operative agents, or a combination of strategies. Conclusions: There are diverse practice variations in anti-thrombotic strategies for free tissue transfers and a difference in perceived risk factors for flap failure that may affect patient management.

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“…Anticoagulation represents a critical element in the management of patients undergoing microsurgical procedures in plastic surgery, including free flap and replantation surgeries. Its primary objective is to prevent thromboembolic complications, which still are the leading cause of flap failure and compromise the overall success of the surgical procedure [1]. On the other hand, extensive use of anticoagulative agents may also increase the risk of bleeding complications, thereby potentially compromising flap viability and overall patient outcome [2].…”

Section: Introductionmentioning

confidence: 99%

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

Biermann,

Chak,

Wiesmeier

et al. 2024

Life

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This systematic review addresses the crucial role of anticoagulation in microsurgical procedures, focusing on free flap reconstruction and replantation surgeries. The objective was to balance the prevention of thrombotic complications commonly leading to flap failure, with the risk of increased bleeding complications associated with anticoagulant use. A meticulous PubMed literature search following Evidence-Based-Practice principles yielded 79 relevant articles, including both clinical and animal studies. The full-texts were carefully reviewed and evaluated by the modified Coleman methodology score. Clinical studies revealed diverse perioperative regimens, primarily based on aspirin, heparin, and dextran. Meta-analyses demonstrated similar flap loss rates with heparin or aspirin. High doses of dalteparin or heparin, however, correlated with higher flap loss rates than low dose administration. Use of dextran is not recommended due to severe systemic complications. In animal studies, systemic heparin administration showed predominantly favorable results, while topical application and intraluminal irrigation consistently exhibited significant benefits in flap survival. The insights from this conducted systematic review serve as a foundational pillar towards the establishment of evidence-based guidelines for anticoagulation in microsurgery. An average Coleman score of 55 (maximum 103), indicating low overall study quality, however, emphasizes the need for large multi-institutional, randomized-clinical trials as the next vital step.

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Efficacy of the postoperative management after microsurgical free tissue transfer

Cited by 17 publications

References 28 publications

Controversies in free tissue transfer for head and neck cancer: A review of the literature

Controversies in free tissue transfer for head and neck cancer: A review of the literature

Multidisciplinary Practice Variations of Anti-Thrombotic Strategies for Free Tissue Transfers

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

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