Is dextran infusion as an antithrombotic agent necessary in microvascular reconstruction of the upper aerodigestive tract?
Patent microvascular anastomoses are mandatory for a successful free tissue transfer. Dextran 40 is widely used by reconstructive microsurgeons in conjunction with free tissue transfer, to prevent flap loss. Unfortunately, dextran-induced adverse reactions, such as anaphylactoid reactions, adult respiratory distress syndrome, cardiac overload, hemorrhage, and renal damage, remain the major risks in routine use of dextran 40. The authors retrospectively analyzed the patency rates of 55 microvascular tissue transfers of a single microsurgeon after tumor ablation of malignancies of the upper aerodigestive tract between August, 1997 and March, 2001. The patency rates of free flap reconstructions were 96 percent for the dextran-infusion group and 100 percent for the dextran-free group. There was no statistically significant difference between the patency rates of these two groups. The results showed that the routine use of dextran as an antithrombotic agent is not necessary in microvascular reconstruction. The disadvantages of dextran infusion can be effectively prevented.
Sun
Tzong-Bor
TB
Division of Plastic Surgery, Department of Surgery, Buddhist Tzu Chi General Hospital and School of Medicine, Tzu Chi University, Hualien, Taiwan.
Chien
Sou-Hsin
SH
Lee
Jiunn-Tat
JT
Cheng
Li-Fu
LF
Hsu
Lee-Ping
LP
Chen
Peir-Rong
PR
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D003911:Dextrans / Q000627:therapeutic use*; D005260:Female; D006258:Head and Neck Neoplasms / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014654:Vascular Patency; D014656:Vascular Surgical Procedures
D000925:Anticoagulants; D003911:Dextrans