title: Effects of aspirin and low-dose heparin in head and neck reconstruction using microvascular free flaps.
abstract: OBJECTIVE
  The success of microvascular free-tissue transfer to the head and neck has been greatly increased secondary to increased experience, yet postoperative anticoagulation continues to be routinely used to prevent pedicle thrombosis. However, there is currently no consensus as to what the ideal regimen, if any, is recommended for postoperative anticoagulation. This study reviews the outcome and incidence of perioperative complications in patients undergoing free flaps for head and neck reconstruction, using a simple postoperative anticoagulation regimen of aspirin and subcutaneous heparin (SQH).
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  With institutional review board approval, the charts of 261 patients undergoing free flap reconstruction from January 2000 to January 2004 were retrospectively reviewed. Patients who received a standard postoperative anticoagulation regimen of SQH (5000 U SC bid) and aspirin (325 mg PO qd) were included in the study (216 patients). Charts were reviewed for postoperative complications, specifically for free flap failure, vascular compromise (arterial insufficiency/venous congestion), and hematoma.
  
  
  RESULTS
  There were six flap failures (2.8%), resulting in an overall free flap survival rate of 97.2%. There were six patients with venous congestion of the flap that required neck exploration (2.8%), and 12 patients with postoperative hematoma (5.6%), requiring surgical intervention.
  
  
  CONCLUSIONS
  The free flap survival rate in patients undergoing head and neck reconstruction using this simple anticoagulation regimen of aspirin and SQH appears to be equivalent to the free flap survival rate in patients using other anticoagulation agents. In addition, aspirin and SQH do not increase the incidence of postoperative hematoma when compared with the other anticoagulation agents. Therefore, aspirin and SQH appear to be reliable postoperative anticoagulation agents for patients undergoing head and neck reconstruction using free flaps.
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School , Boston, Massachusetts 02114, USA.
authors.forename: Wade
authors.initials: W
authors.lastname: Chien
authors.forename: Mark A
authors.initials: MA
authors.lastname: Varvares
authors.forename: Tessa
authors.initials: T
authors.lastname: Hadlock
authors.forename: Mack
authors.initials: M
authors.lastname: Cheney
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Deschler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006257:Head / Q000601:surgery*; D006406:Hematoma / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013524:Surgical Flaps; D013927:Thrombosis / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin; D001241:Aspirin