Use of systemic low-dose unfractionated heparin in microvascular head and neck reconstruction: Influence in free-flap outcomes

Numajiri, Toshiaki; Sowa, Yoshihiro; Nishino, Koichi; Arai, Akihito; Tsujikawa, Takahiro; Ikebuchi, Kaichiro; Nakano, Hiroshi; Sakaguchi, Hirofumi

doi:10.3109/2000656x.2015.1125359

Cited by 16 publications

(56 citation statements)

References 26 publications

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“…After 24 duplicated articles were removed, an initial screening was conducted by reviewing the titles and abstracts; 161 articles that failed to meet the eligibility criteria were excluded, 16 full articles were carefully reviewed, and 12 articles were removed for various reasons (►Supplemental Table 2, online only). Finally, four articles [22][23][24][25] were included in our meta-analysis.…”

Section: Literature Selectionmentioning

confidence: 99%

“…In addition, among them, 943 surgeries involved postoperative anticoagulation therapy, and 1,105 surgeries did not involve the administration of postoperative anticoagulation therapy. All four articles reported the outcomes of flap loss; three articles [22][23][24] reported the outcomes of hematoma formation; and two reported the outcomes of thromboembolic events. Overall, 107 cases of flap loss, 70 cases of hematoma, and 126 cases of thromboembolic events were reported in this review (►Table 2).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Four [22][23][24][25] articles, including 943 cases of anticoagulation therapy and 1,105 cases of nonanticoagulation therapy, studied the occurrence of flap loss. When all the data were pooled in the meta-analysis, there was no significant difference in the occurrence of flap loss between the anticoagulation group and the nonanticoagulation group.…”

Section: Analysis Of Relationship Between Postoperative Anticoagulatimentioning

confidence: 99%

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Does Postoperative Anticoagulation Therapy Lead to a Higher Success Rate for Microvascular Free-Tissue Transfer in the Head and Neck? A Systematic Review and Meta-Analysis

Liu

Shi

Yang

et al. 2017

J reconstr Microsurg

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The findings from our meta-analysis indicate that postoperative anticoagulation therapy barely decreases the risks of flap loss and thromboembolic events in free-flap surgery in the head and neck. However, it may significantly increase the risk of hematoma formation. Considering the limitations of this meta-analysis, additional high-quality, multicenter, prospective, randomized controlled studies are needed to confirm these findings.

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Section: Literature Selectionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Analysis Of Relationship Between Postoperative Anticoagulatimentioning

confidence: 99%

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Does Postoperative Anticoagulation Therapy Lead to a Higher Success Rate for Microvascular Free-Tissue Transfer in the Head and Neck? A Systematic Review and Meta-Analysis

Liu

Shi

Yang

et al. 2017

J reconstr Microsurg

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“…Few clinical studies are suggesting an improvement in outcome [11]. However, the superiority of a therapy regimen is still not evident [9,11,12]. The purpose of this study was to distinguish the difference between flap survival and postoperative complications depending on the use of intravenous low-dose UFH and subcutaneous LMWH in patients undergoing free-flap reconstruction in the head and neck area, to provide a recommendation for clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…Observations in animal studies showed the ability of LMWH to reduce thrombosis formation in microvascular anastomoses [10]. Few clinical studies are suggesting an improvement in outcome [11]. However, the superiority of a therapy regimen is still not evident [9,11,12].…”

Section: Introductionmentioning

confidence: 99%

Postoperative management of antithrombotic medication in microvascular head and neck reconstruction: a comparative analysis of unfractionated and low-molecular-weight heparin

Sievert

Goncalves

Tamse

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Free flap reconstruction is a valuable technique to preserve function in oncological head and neck surgery. Postoperative graft thrombosis is a dreaded risk. This study aims to compare low-dose unfractionated heparin (UFH) and lowmolecular-weight heparin (LMWH) in perioperative thrombosis prophylaxis. Methods This is a retrospective analysis of 266 free flaps performed at our academic center. A comparison was made between 2 patient groups, based on their respective postoperative prophylaxis protocols either with UFH (n = 87) or LMWH (n = 179). Primary endpoints were the frequency of transplant thrombosis and the number of flap failures. Secondary endpoints were the occurrence of peri-and postoperative complications. Results The flap survival rate was 96.6% and 93.3% for the groups UFH and LMWH, respectively (P = 0.280). The rate of postoperative bleeding requiring revision was 4.6% and 6.7% for each group, respectively (P = 0.498). We found a hematoma formation in 4.6% and 3.9% (P = 0.792). Conclusion The free-flap survival rate using low-dose UFH seems to be equivalent to LMWH regimens without compromising the postoperative outcome. Consequently, for risk-adapted thrombosis prophylaxis, either LMWH or UFH can be administrated.

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Success and Outcomes Following a Second Salvage Attempt for Free Flap Compromise in Patients Undergoing Head and Neck Reconstruction

Slijepcevic

Young

Shinn

et al. 2022

JAMA Otolaryngol Head Neck Surg

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free flap compromise is low, with successful salvage in up to 70%. When the flap is compromised a second time, the value of intervening is unknown.OBJECTIVE To assess the outcomes of a second revascularization attempt for compromised free flaps. DESIGN, SETTING, AND PARTICIPANTSThis multicenter retrospective medical record review included patients undergoing head and neck reconstruction with free flaps at 6 US medical centers from January 1, 2000, through December 30, 2020. Patients were 18 years or older with a history of head and neck defects from cancer, osteoradionecrosis, or other wounds. Of 3510 flaps identified, 79 were successfully salvaged once, became compromised a second time, and underwent attempted salvage. MAIN OUTCOME AND MEASUREFlaps with a history of initial compromise and successful revascularization demonstrating second episodes of compromise followed by second salvage attempts.RESULTS A total of 79 patients (mean age, 64 years; 61 [77%] men) were included in the analysis. Of the 79 flaps undergoing second salvage attempts, 24 (30%) survived while 55 (70%) demonstrated necrosis. Arterial or venous thrombectomy was performed in 17 of the 24 (71%) flaps that survived and 23 of the 55 (42%) flaps demonstrating necrosis (odds ratio, 3.38; 95% CI, 1.21-9.47). When venous compromise was encountered, changing the anastomotic vein was associated with decreased survival compared with not changing the vein (29 of 55 [53%] flaps vs 10 of 24 [42%] flaps); vein revision to an alternative branch was completed in 1 of the 24 (4%) flaps that survived and 19 of the 55 (35%) flaps with necrosis (odds ratio, 0.08; 95% CI, 0.00-0.60). Factors that were not associated with flap survival following second salvage attempts included flap type, cause of flap failure, postoperative complications, patient comorbidities, and heparin administration after second salvage. CONCLUSIONS AND RELEVANCEIn this cohort study, second salvage was successful in 30% of free flaps. Flaps that underwent arterial or venous thrombectomy demonstrated better survival, while vein revision to neighboring branch veins was associated with worse flap outcomes.

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Use of systemic low-dose unfractionated heparin in microvascular head and neck reconstruction: Influence in free-flap outcomes

Abstract: Heparin increased the haematoma formation, but did not change the incidence of free-flap failure. Thus, the intravenous low-dose heparin use does not affect microvascular flap survival.

Cited by 16 publications

References 26 publications

Does Postoperative Anticoagulation Therapy Lead to a Higher Success Rate for Microvascular Free-Tissue Transfer in the Head and Neck? A Systematic Review and Meta-Analysis

Does Postoperative Anticoagulation Therapy Lead to a Higher Success Rate for Microvascular Free-Tissue Transfer in the Head and Neck? A Systematic Review and Meta-Analysis

Postoperative management of antithrombotic medication in microvascular head and neck reconstruction: a comparative analysis of unfractionated and low-molecular-weight heparin

Success and Outcomes Following a Second Salvage Attempt for Free Flap Compromise in Patients Undergoing Head and Neck Reconstruction

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