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Does Intraoperative Systemic Anticoagulation After Anastomosis Revision Improve Outcomes in Head and Neck Free Flap Reconstruction?
Mohsina Subair, Fuat Baris Bengur, Preetha Velu, Mark Kubik, Chaud Sridharan, Mario G Solari
Department of Plastic Surgery, UPMC, Pittsburgh
2024-01-12
Presenter: Mohsina Subair
Affidavit:
The paper represents the original work of the resident and she was involved in design, data collection, data analysis and authoring the abstract.
Director Name: MARIO G SOLARI
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Purpose: Heparin drip is often started intraoperatively when there is concern for postoperative thrombosis, especially, in setting of an anastomotic revision (AR). We aimed to determine the outcomes following intraoperative systemic anticoagulation in head and neck free flaps requiring AR to help guide future use.
Methods: This was a single centre retrospective review of all patients who underwent head and neck free flap reconstruction from 2012 to 2022. Data including anastomosis revision, flap loss, and return to the operating room was extracted from our Head and Neck free flap database.
Results: Among 1174 patients included, 77(6.5%) had AR.Flap-loss was 2% overall and 20%(16/77) in AR group. Intraoperative heparin-drip was administered in 35 patients, 22 at index &13 at take-back surgery. Among AR patients, heparin group had significantly higher bleeding rates(23%vs7%;OR=3.65,p=0.027) with similar flap failure rates(20%vs 22%,p=0.804).In patients with AR at index surgery(52/77), heparin drip resulted in a higher rate of bleeding(11%vs6%,p=0.51) with lesser flap loss rates(6%vs 9%;p=0.67). In patients with an identifiable thrombus(45%), use of heparin-drip significantly reduced flap failure (25% vs 81%p=0.002) with similar bleeding (29% vs 27%p=0.98) when compared with patients who did not receive heparin-drip. In patients without identifiable thrombus (54%), use of heparin-drip had relatively higher bleeding rates (14%vs3%, p=0.24) with similar flap failure rate(0 vs 3%,p=0.79)
Conclusion: In patients needing AR, intraoperative systemic anticoagulation was associated with better flap outcomes when a thrombus was identified. In the absence of an identifiable thrombus, there was a significantly higher rate of bleeding with comparable flap survival rates.
