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Role of anti-coagulation and anti-platelet post free flap salvage for thrombosis related vascular compromise
Mike Tran
Moheb Said
Summa Health - Akron City
2022-01-14
Presenter: Mike Tran
Affidavit:
80% of the work on this project represents the original work of the fellow/resident
Director Name: Ananth S Murthy
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
BACKGROUND:
Microvascular compromise post free tissue transfer is devastating and may necessitate arduous, risky, and costly salvage procedure(s). Venous compromise rate exceeds arterial and successful salvage depends primarily on time to re-exploration. The paucity of data that exists suggests post-salvage anti-coagulation and/or anti-platelet is under-utilized. Successful salvage therefore may be further optimized.
METHODS:
We conducted a single institution retrospective review of patients requiring salvage following free flap reconstruction from 2012 to 2021. Patient-centric (demographics, comorbidities, baseline labs, etc), post-reconstruction data (time to salvage, monitoring protocol, anastomosis, etc), salvage maneuvers, and post-salvage anticoagulation / antiplatelet use was recorded. We performed multivariate analysis to determine total flap loss in the group that received heparin / aspirin to those that did not.
RESULTS:
27 demographically similar patients were identified with an overall success rate of 63%. Post-salvage heparin and/or aspirin use confers a success rate of 90% versus a 50% success rate in those that did not (R2 = 0.144; P = <0.001). Multivariate analysis shows diminished predictive power when compared with salvaging arterial vs venous compromise and time to re-exploration. All other factors were not predictive of success.
CONCLUSION:
Time to salvage and venous vs arterial thrombosis significantly correlated with salvage success and reflects current literature. Post-salvage heparin and/or aspirin ameliorated total flap loss due thrombosis. Ongoing analysis may lead to an implementable, data-driven anti-coagulation and/or anti-platelet protocol to optimize free flap salvage success.
