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

Abstract

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.

Cerium Dioxide–Dextran Nanocomposites in the Development of a Medical Product for Wound Healing: Physical, Chemical and Biomedical Characteristics

“…Currently, there is an active search for optimal ways to create new wound-healing drugs with a better balance of regenerative and antimicrobial effect of a new type that does not cause antibiotic resistance. Great hopes are placed on nanocomposites based on cerium oxide nanoparticles [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ], which is a rare earth metal with variable valence, coated with a polymer shell, dextran [ 50 , 51 , 52 , 53 , 54 ], which is widely used in medicine [ 67 , 68 , 69 ]. This complex seems to be an excellent combination for the development of a medical drug that effectively accelerates wound healing.…”