Safety and Efficacy of Low Molecular Weight Dextran (Dextran 40) in Head and Neck Free Flap Reconstruction

Jayaprasad, Kiran; Mathew, Jimmy; Thankappan, Krishnakumar; Sharma, Mohit; Duraisamy, Sriprakash; Rajan, Sunil; Paul, Jerry; Iyer, Subramania

doi:10.1055/s-0033-1343950

Cited by 25 publications

(18 citation statements)

References 23 publications

(38 reference statements)

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“…Among previous studies that have specifically compared different antithrombotic agents regarding haematoma and thrombosis in free flap surgery [4,[6][7][8][9][10][11][12] (Table 5), only one prospective randomised study could be identified [10]. In accordance with the study by Disa et al [10], where they evaluated the use of dextran in 100 head and neck free flap cases, we omitted peri-and postoperative dextran from our treatment protocol in 2011.…”

Section: Discussionmentioning

confidence: 99%

“…dextran). Several animal studies have demonstrated favourable effects on free flap outcome by these different agents, whereas clinical studies have failed to reproduce these results in humans [4,[6][7][8][9][10][11][12]. Although most agents are used to prevent systemic thrombosis today, many centres still use different agents to improve the flap outcome [4,13].…”

Section: Introductionmentioning

confidence: 99%

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Breast free flap complications related to haematoma formation – do the risks of multiple antithrombotics outweigh the benefits today?

Halle

Skogh

Friberg

et al. 2016

Journal of Plastic Surgery and Hand Surgery

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Background Free flap reconstruction is today a common operation for many breast cancer patients, but local protocols for microsurgery still predict the use of antithrombotic agents. Reduced operation times and complication rates together with faster mobilisation, after introduction of perforator flaps, call for less comprehensive antithrombotic regimens. It was hypothesised that multiple antithrombotics was a risk factor for bleeding-related flap complications. Methods A retrospective cohort study was conducted to study the association between reoperation for haematoma and flap-related complications after free flap breast reconstruction. A combination of heparin, low-molecular-weight heparin and dextran were used as antithrombotics. A sub-analysis was performed to compare non-dextran to dextran treated patients. Results One hundred and thirty-nine patients were identified, reconstructed with 150 consecutive perforator free flaps to the breast. Reoperation for breast haematoma (13%) was associated with concomitant re-operation for venous congestion (8.6%) (p < 0.001), but also for flap thrombosis (2.9%) (p = 0.007), highlighting haematoma as a risk factor for flap-related complications. An increased rate of haematoma re-operations of the breast was noted among the flap-related complications in the dextran (n = 79), compared to the non-dextran group (p = 0.011). Conclusion The current study highlights the use of multiple antithrombotics as a risk factor for haematoma reoperation. Liberal use of drains and evacuation of breast haematomas are, therefore, indicated together with limitation of antithrombotic agents. The highly variable use of antithrombotic agents worldwide call for evidence-based guidelines in standardised free flap breast reconstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Breast free flap complications related to haematoma formation – do the risks of multiple antithrombotics outweigh the benefits today?

Halle

Skogh

Friberg

et al. 2016

Journal of Plastic Surgery and Hand Surgery

View full text Add to dashboard Cite

show abstract

“…The remaining 19 studies were retrospective cohort studies. [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Study characteristics are summarized in Table 2.…”

Section: Study Qualitymentioning

confidence: 99%

Benefits and Risks of Prophylaxis for Deep Venous Thrombosis and Pulmonary Embolus in Plastic Surgery

Pannucci¹,

MacDonald

Ariyan³

et al. 2016

Plastic and Reconstructive Surgery

122

111

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“…One study was not in English, Dutch or German. 19 These seven studies were excluded; hence, 15 publications remained for critical appraisal [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] (Table 1).…”

Section: Search and Selectionmentioning

confidence: 99%

The value of postoperative anticoagulants to improve flap survival in the free radial forearm flap: a systematic review and retrospective multicentre analysis

Swartz

Aarts

Swart

et al. 2015

Clinical Otolaryngology

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Background Free radial forearm flap (FRFF) reconstruction is a valuable technique in head and neck surgery, that allows closure of large defects while striving to maintain functionality. Anticoagulative drugs are often administered to improve flap survival, although evidence regarding effectiveness is lacking. Objective of review To investigate the effectiveness of postoperative anticoagulants to improve survival of the FRFF in head and neck reconstruction. Type of review Systematic review and multicenter, individual patient data meta-analysis. Search strategy MEDLINE, EMBASE, Web of Science and CINAHL were searched for synonyms of ‘anticoagulants’ and ‘free flap reconstruction’. Evaluation method Studies were critically appraised for directness of evidence and risk of bias. Authors of the highest quality publications were invited to submit their original data for meta-analysis. Results Five studies were of adequate quality and data from four studies (80%) were available for meta-analysis, describing 759 FRFF procedures. Anticoagulants used were: aspirin (12%), low-molecular weight dextran (18.3%), unfractioned heparin (28.1%), low-molecular weight heparin (49%) and prostaglandin-E1 (2.1%). Thirty-one percent did not receive anticoagulants. Flap failure occurred in 40 of 759 patients (5.3%) On univariate analysis, use of unfractioned heparin was associated with a higher rate of flap failure. However, these regimens were often administered to patients who had revision surgery of the anastomosis. In multivariate logistic regression analysis, anticoagulant use was not associated with improved flap survival or flap-related complications. Conclusions The studied anticoagulative drugs did not improve FRFF survival or lower the rate of flap-related complications. In addition some anticoagulants may cause systemic complications.

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Safety and Efficacy of Low Molecular Weight Dextran (Dextran 40) in Head and Neck Free Flap Reconstruction

Abstract: Though dextran 40 did not result in any significant adverse local or systemic complications, it is not useful as a postoperative antithrombotic agent in head and neck oncologic reconstruction with free tissue transfer.

Cited by 25 publications

References 23 publications

Breast free flap complications related to haematoma formation – do the risks of multiple antithrombotics outweigh the benefits today?

Breast free flap complications related to haematoma formation – do the risks of multiple antithrombotics outweigh the benefits today?

Benefits and Risks of Prophylaxis for Deep Venous Thrombosis and Pulmonary Embolus in Plastic Surgery

The value of postoperative anticoagulants to improve flap survival in the free radial forearm flap: a systematic review and retrospective multicentre analysis

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