title: Use of systemic low-dose unfractionated heparin in microvascular head and neck reconstruction: Influence in free-flap outcomes.
abstract: BACKGROUND
  Intravenous heparin administration is used to prevent thrombosis in free-flap transfer. However, it is unknown whether the use of heparin affects free-flap survival. The purpose of this study is to investigate the effect of heparin in free flap transfer.
  
  
  METHODS
  Two hundred and six patients who received ablative surgery for head and neck cancer were classified into three groups. Group A received ablative surgery, neck dissection, and free-flap reconstruction, and postoperatively they were administered continuous intravenous unfractionated heparin (5000-10 000 units/day) until postoperative day 7 (POD7); group B received the same procedures as group A but without heparin; group C received only ablative surgery and neck dissection without heparin. As indicators of coagulation time, the prothrombin time-international normalised ratio (PT-INR) and the activated partial thromboplastin time (APTT) were measured, before surgery and on POD1, 3, and 7. Flap failure, bleeding, haematoma formation, re-exploration, and thromboembolic events were recorded.
  
  
  RESULTS
  The PT-INR and APTT were 1.3-1.5-times longer in group A (p < 0.01), and 1.3-times longer (p < 0.01) in group B. The PT-INR and APTT were higher in groups A and B than C (p < 0.01). The free-flap success rate was not affected. Only the incidence of haematoma was increased in group A (p = 0.04).
  
  
  CONCLUSIONS
  Heparin increased the haematoma formation, but did not change the incidence of free-flap failure. Thus, the intravenous low-dose heparin use does not affect microvascular flap survival.
authors.affiliation: a Department of Plastic and Reconstructive Surgery , Kyoto Prefectural University of Medicine , Kyoto , Japan and.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Numajiri
authors.affiliation: a Department of Plastic and Reconstructive Surgery , Kyoto Prefectural University of Medicine , Kyoto , Japan and.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sowa
authors.affiliation: a Department of Plastic and Reconstructive Surgery , Kyoto Prefectural University of Medicine , Kyoto , Japan and.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nishino
authors.affiliation: b Department of Otorhinolaryngology , Kyoto Prefectural University of Medicine , Kyoto , Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Arai
authors.affiliation: b Department of Otorhinolaryngology , Kyoto Prefectural University of Medicine , Kyoto , Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsujikawa
authors.affiliation: b Department of Otorhinolaryngology , Kyoto Prefectural University of Medicine , Kyoto , Japan.
authors.forename: Kaichiro
authors.initials: K
authors.lastname: Ikebuchi
authors.affiliation: b Department of Otorhinolaryngology , Kyoto Prefectural University of Medicine , Kyoto , Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakano
authors.affiliation: b Department of Otorhinolaryngology , Kyoto Prefectural University of Medicine , Kyoto , Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Sakaguchi
mesh_terms: D055011:Ablation Techniques; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D016022:Case-Control Studies; D005260:Female; D058752:Free Tissue Flaps; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006406:Hematoma / Q000209:etiology; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D037981:Neck Dissection; D010314:Partial Thromboplastin Time; D011183:Postoperative Complications; D011517:Prothrombin Time; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013927:Thrombosis / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Microsurgery; anterolateral thigh; anti-coagulants; free jejunum; haematoma