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Free Flap Surgery Outcome Related to Antithrombotic Treatment Regime: An Analysis of 1000 Cases
BACKGROUND: Autologous free tissue transfer is today an integral part of reconstructive plastic surgery, but still lacks generally accepted guidelines regarding antithrombotic agents. We hypothesized that the overuse of antithrombotic agents could be a risk factor for free flap complications and the...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8647881/ https://www.ncbi.nlm.nih.gov/pubmed/34881134 http://dx.doi.org/10.1097/GOX.0000000000003961 |
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author | Jakobsson, Stina Kamali, Alexander Edsander Nord, Åsa Sommar, Pehr Halle, Martin |
author_facet | Jakobsson, Stina Kamali, Alexander Edsander Nord, Åsa Sommar, Pehr Halle, Martin |
author_sort | Jakobsson, Stina |
collection | PubMed |
description | BACKGROUND: Autologous free tissue transfer is today an integral part of reconstructive plastic surgery, but still lacks generally accepted guidelines regarding antithrombotic agents. We hypothesized that the overuse of antithrombotic agents could be a risk factor for free flap complications and therefore studied a treatment protocol adjustment. METHODS: Consecutive free flaps between 2005 and 2020 at a single center were analyzed for complications in relation to the use of pre- and intraoperative treatment with three different antithrombotic agents. The use of preoperative low molecular weight heparin (LMWH), intraoperative heparin, and dextran were analyzed in relation to outcome variables, thromboembolic events, or reexploration for hematoma. RESULTS: Nine hundred thirty-one patients underwent 1000 microvascular free flaps for breast (n = 487), head and neck (n = 365), and extremity (n = 148) reconstruction. Within the first postoperative week, 44 cases had a thromboembolic event and 58 cases underwent hematoma-related reexploration. In the multivariate analysis, thromboembolic events were associated with extremity reconstruction (P = 0.02) and smoking (P = 0.02). Hematoma-related reexploration was more common with triple antithrombotic therapy compared with all other treatment regimes (P < 0.05). The number of antithrombotic agents used perioperatively was linearly decreased, from three to none, over the elapsed time period (P < 0.001). CONCLUSIONS: Hematoma was the most common reason for reexploration and was further associated with the use of multiple antithrombotic agents. Cessation of triple treatment was associated with less hematomas and further reduction of antithrombotic agents did not result in any increase of thromboembolic events. Evidence-based guidelines are warranted for antithrombotic regimes in standard free flap surgery. |
format | Online Article Text |
id | pubmed-8647881 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-86478812021-12-07 Free Flap Surgery Outcome Related to Antithrombotic Treatment Regime: An Analysis of 1000 Cases Jakobsson, Stina Kamali, Alexander Edsander Nord, Åsa Sommar, Pehr Halle, Martin Plast Reconstr Surg Glob Open Reconstructive BACKGROUND: Autologous free tissue transfer is today an integral part of reconstructive plastic surgery, but still lacks generally accepted guidelines regarding antithrombotic agents. We hypothesized that the overuse of antithrombotic agents could be a risk factor for free flap complications and therefore studied a treatment protocol adjustment. METHODS: Consecutive free flaps between 2005 and 2020 at a single center were analyzed for complications in relation to the use of pre- and intraoperative treatment with three different antithrombotic agents. The use of preoperative low molecular weight heparin (LMWH), intraoperative heparin, and dextran were analyzed in relation to outcome variables, thromboembolic events, or reexploration for hematoma. RESULTS: Nine hundred thirty-one patients underwent 1000 microvascular free flaps for breast (n = 487), head and neck (n = 365), and extremity (n = 148) reconstruction. Within the first postoperative week, 44 cases had a thromboembolic event and 58 cases underwent hematoma-related reexploration. In the multivariate analysis, thromboembolic events were associated with extremity reconstruction (P = 0.02) and smoking (P = 0.02). Hematoma-related reexploration was more common with triple antithrombotic therapy compared with all other treatment regimes (P < 0.05). The number of antithrombotic agents used perioperatively was linearly decreased, from three to none, over the elapsed time period (P < 0.001). CONCLUSIONS: Hematoma was the most common reason for reexploration and was further associated with the use of multiple antithrombotic agents. Cessation of triple treatment was associated with less hematomas and further reduction of antithrombotic agents did not result in any increase of thromboembolic events. Evidence-based guidelines are warranted for antithrombotic regimes in standard free flap surgery. Lippincott Williams & Wilkins 2021-12-06 /pmc/articles/PMC8647881/ /pubmed/34881134 http://dx.doi.org/10.1097/GOX.0000000000003961 Text en Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Reconstructive Jakobsson, Stina Kamali, Alexander Edsander Nord, Åsa Sommar, Pehr Halle, Martin Free Flap Surgery Outcome Related to Antithrombotic Treatment Regime: An Analysis of 1000 Cases |
title | Free Flap Surgery Outcome Related to Antithrombotic Treatment Regime: An Analysis of 1000 Cases |
title_full | Free Flap Surgery Outcome Related to Antithrombotic Treatment Regime: An Analysis of 1000 Cases |
title_fullStr | Free Flap Surgery Outcome Related to Antithrombotic Treatment Regime: An Analysis of 1000 Cases |
title_full_unstemmed | Free Flap Surgery Outcome Related to Antithrombotic Treatment Regime: An Analysis of 1000 Cases |
title_short | Free Flap Surgery Outcome Related to Antithrombotic Treatment Regime: An Analysis of 1000 Cases |
title_sort | free flap surgery outcome related to antithrombotic treatment regime: an analysis of 1000 cases |
topic | Reconstructive |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8647881/ https://www.ncbi.nlm.nih.gov/pubmed/34881134 http://dx.doi.org/10.1097/GOX.0000000000003961 |
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