A Review of Thrombosis and Antithrombotic Therapy in Microvascular Surgery

Abstract

Despite a remarkable expansion of microsurgery, there is still no international consensus about routinely used prophylactic antithrombotic agents. Most treatment regimens still use aspirin, heparin (low-molecular-weight and unfractionated heparin) or colloids (hydroxyphenylacetate 6%/dextran); however, clear evidence for the clinical benefit of an ideal administration regimen or one agent over the other has not yet been established. Instead of searching for the one regime that fits all, an increasing number of reviews from different disciplines describe multistep approaches that optimize what has been shown to be most promising. This includes the use of antithrombotic agents, proper risk assessment, secondary prevention and professional training to optimize microsurgical skills. In this review, we describe factors included in traditional approaches and also emphasize the value of good surgical technique, which while recognized by all to be one of the most important factors for success, receives less emphasis in reviews describing thrombosis prophylaxis in microvascular surgery.

Coulomb nanoradiator-mediated, site-specific thrombolytic proton treatment with a traversing pristine Bragg peak

“…Therefore, chemical-based rheolytic mechanisms avoid the potentially serious complications that have been associated with distal embolization, haemolysis, and haemoglobinuria resulting from mechanical fragmentation or maceration of thrombi4.…”

“…Vascular inflammation, disruption of the blood-brain barrier, and secondary thrombosis limit the therapeutic window for the treatment of stroke thrombolysis with tPA to 3 hours3. Platelet-rich emboli occlusions in replanted tissues and free flaps often lead to failure in microvascular surgery4. Distal embolization from the disrupted plaque56 is one difficulty associated with angioplasty and other focal treatment techniques.…”

Testing a New Anticoagulation Method for Free Flap Reconstruction of Head and Neck Cancers

“…Despite the improvement in the surgical techniques and the surgeons’ experiences, flap failures still occur due to thrombotic occlusion after small vessels anastomosis [3,4]. During the first hours and days after free flap transfer, the flap is perfused only via anastomosed microvascular circulation.…”

“…Therefore, monitoring of free flaps during the first 24 hours is critical and of particular importance in 3 to 5 days after surgery [8]. To reduce the possibility of flap loss as a result of thrombotic occlusion, various anticoagulants including aspirin, heparin, low molecular weight heparin (LMWH), dextran, and prostaglandin E1 have been used [3,4,9]. …”

Behavior of anastomozed vessels and transferred flaps after anastomosed site infection in head and neck microsurgical reconstruction

“…Some reports showed that infection did not affect pedicle patency and the flap failure 8,9 while other reports described thrombosis and flap failure caused by infection. [10][11][12][13] Therefore, we aimed to assess the behavior of anastomosed vessels and transferred flaps when an anastomosed site infection occurs, and to determine the optimal procedure to manage the infection. Here, we describe the postoperative courses of our 11 free-flap cases after infection at the vascular pedicle site, wherein the patency could be observed macroscopically after re-exploration and pus drainage.…”