Hepatic artery reconstruction in living donor liver transplantation: strategy of the extension of graft or recipient artery

Continuous local intravenous heparin infusion after re‐exploration for venous congestion in free‐flap breast reconstruction: A case series

“…Systemic heparin administration using insufficient doses, however, does not benefit flap salvage 11 . To prolong aPTT to the effective range (1.5–2.3 times higher than normal), a high dose of systemic heparin (>18 U/kg/h) is required 13 . This high dose causes bleeding and the formation of hematoma(s) 13 .…”

“…To prolong aPTT to the effective range (1.5–2.3 times higher than normal), a high dose of systemic heparin (>18 U/kg/h) is required 13 . This high dose causes bleeding and the formation of hematoma(s) 13 . In contrast, local administration does not require a high dose, because in this case, heparin acts directly at a high concentration in the flap 10,11 .…”

“…Animal experiments have revealed that even low‐dose heparin (5–6 U/kg/h) delivered locally to the flap has sufficient and beneficial action 11 . Another in vivo study showed that the rate of postoperative bleeding complications was significantly higher in cases of local administration of heparin at >6.5 U/kg/h 13 . We decided on the dose of heparin—not only in reference to these reports—but also considering the condition of re‐explorations.…”

“…Systemic and local administration routes for heparin infusion have been reported after re‐exploration for venous congestion of free flaps. 3 , 10 , 13 Systemic administration is not technically difficult because it does not require an injection route into the flap vessels. Systemic heparin administration using insufficient doses, however, does not benefit flap salvage.…”

“… 13 This high dose causes bleeding and the formation of hematoma(s). 13 In contrast, local administration does not require a high dose, because in this case, heparin acts directly at a high concentration in the flap. 10 , 11 Local administration routes are divided into two types: intra‐arterial and intravenous.…”