Perioperative management of antithrombotic medication in head and neck reconstruction-a retrospective analysis of 137 patients.
OBJECTIVE
Various protocols exist to prevent thrombosis after free flap surgery in the head and neck. This study reviews the outcome and incidence of perioperative complications in patients undergoing head and neck reconstruction, simply using subcutaneous low-molecular-weight heparin.


METHODS
A total of 137 free tissue transfers performed between 2007 and 2010 were reviewed. All patients received a general thrombosis prophylaxis with subcutaneous low-molecular-weight enoxaparin. No aspirin, dextran, or additional antithrombotic medication was administered.


RESULTS
Overall flap survival was 97.1%. A total of 3 complete and 1 partial flap loss occurred, all due to venous thrombosis. Five cases of venous congestion were successfully revised.


CONCLUSIONS
The free flap survival rate using simple subcutaneous heparin seems to be equivalent to other management regimens. Therefore, we suggest that no additional antithrombotic treatment is needed for patients who undergo head and neck reconstruction with free tissue transfer.
Department of Otolaryngology and Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany. maximilian.reiter@med.uni-muenchen.de
Maximilian
M
Reiter
Markus
M
Kapsreiter
Christian S
CS
Betz
Ulrich
U
Harréus
D000925:Anticoagulants / Q000008:administration & dosage; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006085:Graft Survival / Q000187:drug effects; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight