[Should adjuvant treatments (antiplatelet agents, anticoagulants, normovolaemic haemodilution and vasodilators) be used in cervicofacial and maxillofacial free flaps reconstructive surgery?].
The ENT and maxillo-facial reconstruction with free flaps has become a standard. The objective of the adjuvant treatments is to limit failures (approximately 6%) related to ischaemia/reperfusion. French surgical centres use specific protocols depending on the surgeon. They used antiplatelet agent, anticoagulants, normovolemic hamodilution and vasodilators. Many experimental studies are available. However, there is no clinical study to recommend the use of antiplatelet agents (combination with heparin increase the risk of pre- and postoperative bleeding), of normovolemic hemodilution (pulmonary oedema) and of vasodilators. After analysis of one of the only prospective study, we propose the use of heparin following a deep vein thrombosis preventive protocol. Due to the limited number of the patients and difficulty to have homogenous series, it is impossible to draw new recommendations, even if ischemic preconditioning techniques offer new research horizons.
Péan
D
D
Service d'anesthésie-réanimation chirurgicale, Hôtel-Dieu, CHU, 44093 Nantes cedex 01, France. didier.pean@chu-nantes.fr <didier.pean@chu-nantes.fr>
Béliard
C
C
D000925:Anticoagulants / Q000627:therapeutic use*; D005145:Face / Q000601:surgery*; D005602:France; D006438:Hemodilution; D006801:Humans; D019647:Oral Surgical Procedures; D013517:Otorhinolaryngologic Surgical Procedures; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019651:Plastic Surgery Procedures; D015427:Reperfusion Injury / Q000517:prevention & control; D013524:Surgical Flaps / Q000009:adverse effects*; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents