The Effects of Ketorolac on Microvascular Thrombosis in Lower Extremity Reconstruction

Lee, Kyeong Tae; Jeon, Byung-Joon; Lim, So-Young; Pyon, Jai-Kyung; Bang, Sa Ik; Kap-Sung, Oh; Mun, Goo‐Hyun

doi:10.1097/prs.0b013e31824ec33f

Cited by 25 publications

(34 citation statements)

References 26 publications

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“…*Ketorolac is associated with lower rates of microvascular complications following lower extremity reconstruction. 44 and poor flap outcomes in patients. 22 Preoperative hemoglobin values below 10 g/dl are a significant predictor of flap failure and thrombosis.…”

Section: Blood Transfusionmentioning

confidence: 98%

“…43 Another study suggested that ketorolac reduces thrombotic complications in lower extremity free flaps. 44 In a prospective, randomized, double-blind trial of free TRAM flap breast reconstruction patients, a continuous infusion pump system delivering bupivacaine resulted in significantly reduced patientcontrolled analgesia narcotic use, an earlier transition to oral narcotics, and improved overall pain scores. 42 Similarly, donor-site nerve block with bupivacaine following abdominal free flap breast reconstruction also reduced postoperative patientcontrolled analgesia narcotic use.…”

Section: Analgesiamentioning

confidence: 99%

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Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Motakef

Mountziaris

Ismail

et al. 2015

Plastic and Reconstructive Surgery

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Current practices remain exceedingly diverse. Key strategies to improve patient outcomes can be defined from the available literature. Key evidence-based guidelines included that normothermia should be maintained perioperatively to improve outcomes (level of evidence 2b), and volume replacement should be maintained between 3.5 and 6.0 ml/kg per hour (level of evidence 2b). Vasopressors do not harm outcomes and may improve flap flow (level of evidence 1b), with most evidence supporting the use of norepinephrine over other vasopressors (level of evidence 1b). Dextran should be avoided (level of evidence 1b), and pump systems for local anesthetic infusion are beneficial following free flap breast reconstruction (level of evidence 1b). Further prospective studies will improve the quality of available evidence.

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Section: Blood Transfusionmentioning

confidence: 98%

Section: Analgesiamentioning

confidence: 99%

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Motakef

Mountziaris

Ismail

et al. 2015

Plastic and Reconstructive Surgery

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show abstract

“…158 Postoperative ketorolac may be protective against vascular thrombosis, with the added benefit of pain control (Level III Evidence). 159 In conclusion, there is still controversy regarding the most effective anticoagulation protocol for free flap surgery. There have not been enough data to refute Level I evidence that subcutaneous heparin is protective for microvascular thrombosis rate.…”

Section: Postoperative Protocols Anticoagulationmentioning

confidence: 99%

Evidence to Support Controversy in Microsurgery

Fan

Patel

Mardini

et al. 2015

Plastic and Reconstructive Surgery

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Microsurgery practice, including preoperative patient selection, intraoperative technique, and anesthetic considerations, varies from institution to institution and from surgeon to surgeon. Many surgeons' practices are driven by "conventional wisdom," which is handed down from mentors to fellows and residents. In this article, the authors explore the oxymoron that there is evidence to support controversy in microsurgery. Indeed, if there was convincing evidence to support varying microsurgery practices, there would be no controversy. The authors conducted a review with a focus on evidence-based medicine to support microsurgery practice.

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“…Two studies did not collect individual patient data, 9,14 but described a survey held among surgeons. Four studies described only free flap reconstruction outside the head and neck region (lower leg [15][16][17] and post-mastectomy 18 ). One study was not in English, Dutch or German.…”

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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The Effects of Ketorolac on Microvascular Thrombosis in Lower Extremity Reconstruction

Abstract: Therapeutic, III.

Cited by 25 publications

References 26 publications

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Evidence to Support Controversy in Microsurgery

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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