title: Development of consensus guidelines for venous thromboembolism prophylaxis in patients undergoing microvascular reconstruction of the mandible.
abstract: BACKGROUND
  The purpose of this study was to determine how guidelines for venous thromboembolism prophylaxis can be applied to patients undergoing microsurgical reconstruction of the mandible.
  
  
  METHODS
  Retrospective review of our institutional use of thromboprophylaxis and the associated outcomes in 114 patients (58 free fibular flaps and 56 osteocutaneous radial forearm flaps).
  
  
  RESULTS
  Twenty-two patients (19.3%) received only intermittent pneumatic compression. Overall, 80.7% received postoperative chemoprophylaxis. Sixty-four percent initiated chemoprophylaxis within 24 hours after surgery. Only 13.2% received the recommended frequency of chemoprophylaxis. One patient had development of a pulmonary embolism. Four patients undergoing chemoprophylaxis had development of neck hematomas; in each case the cause of bleeding could be attributed to a cause distinct from chemoprophylaxis.
  
  
  CONCLUSIONS
  No consistent chemoprophylaxis protocol was followed. Chemoprophylaxis was not associated with an increased risk of bleeding. Physician education is the next step in decreasing variations in chemoprophylaxis and adopting guidelines similar to The American College of Chest Physicians.
authors.affiliation: Division of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. deleyiannis.frederic@tchden.org
authors.forename: Frederic W-B
authors.initials: FW
authors.lastname: Deleyiannis
authors.forename: Julio A
authors.initials: JA
authors.lastname: Clavijo-Alvarez
authors.forename: Benson
authors.initials: B
authors.lastname: Pullikkotil
authors.forename: Rami
authors.initials: R
authors.lastname: Zanoun
authors.forename: Tiffany
authors.initials: T
authors.lastname: Behringer
authors.forename: Tae W
authors.initials: TW
authors.lastname: Chong
authors.forename: J Peter
authors.initials: JP
authors.lastname: Rubin
authors.forename: Jonas T
authors.initials: JT
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D008297:Male; D008334:Mandible / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D019637:Orthopedic Procedures; D017410:Practice Guidelines as Topic; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants