title: Efficacy of the postoperative management after microsurgical free tissue transfer.
abstract: BACKGROUND
  The physical and medical postoperative measures after free flap reconstruction vary substantially between surgical units. The objective of this review was to identify the postoperative measures which proved a significant positive effect on free flap survival.
  
  
  METHODS
  A review was conducted in the MEDLINE database on the English and French literature.
  
  
  CONCLUSIONS
  Twenty-eight articles were retained. A meta-analysis of 4984 patients who were given antithrombotics (viz. antiplatelets and anticoagulants) postoperatively found that these treatments were of no significant benefit to free flap survival and increased the risk of postoperative hematoma. Postoperative transfusions did not favor free flap survival and were associated with a higher incidence of medical complications. Preoperative anemia was a risk factor for free flap failure. Blood pressure control, vasodilators, antioxidants, corticotherapy, oxygen therapy, and prolonged immobilization were of no proven benefit.
  
  
  CONCLUSIONS
  No postoperative therapy, whether drug-based or not, has been shown to have a significant positive effect on free flap survival.
authors.affiliation: Department of Maxillofacial Surgery, Stomatology and Facial Plastic Surgery, Hospices Civils de Lyon - Claude-Bernard-Lyon 1 University, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France. Electronic address: n.sigaux@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Sigaux
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Hospices Civils de Lyon - Claude-Bernard-Lyon 1 University, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Philouze
authors.affiliation: Department of Plastic, Reconstructive and Esthetic Surgery - Croix Rousse Hospital, Hospices Civils de Lyon - Claude-Bernard-Lyon 1 University, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
authors.forename: F
authors.initials: F
authors.lastname: Boucher
authors.affiliation: Department of Maxillofacial Surgery, Stomatology and Facial Plastic Surgery, Hospices Civils de Lyon - Claude-Bernard-Lyon 1 University, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
authors.forename: M
authors.initials: M
authors.lastname: Jacquemart
authors.affiliation: Department of Plastic, Reconstructive and Esthetic Surgery, Centre Léon-Bérard - Cancer Treatment Center, 28 rue Laënnec, 69008 Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Frobert
authors.affiliation: Department of Maxillofacial Surgery, Stomatology and Facial Plastic Surgery, Hospices Civils de Lyon - Claude-Bernard-Lyon 1 University, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
authors.forename: P
authors.initials: P
authors.lastname: Breton
mesh_terms: D058752:Free Tissue Flaps / Q000637:transplantation*; D006085:Graft Survival; D006406:Hematoma / Q000150:complications; D006801:Humans; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011184:Postoperative Period; D055031:Primary Graft Dysfunction / Q000453:epidemiology / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D013927:Thrombosis / Q000150:complications / Q000453:epidemiology; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome
keywords: Antithrombotics; Blood transfusion; Free flaps; Microsurgery