Abstract：
OBJECTIVE: To survey practices concerning the use of anticoagulants and antiplatelets in microvascular free-flap reconstruction following oncological surgery of the head and neck.
METHODS: A survey of practices was carried out between September 2022 and March 2023. An online questionnaire was sent to members of the French GETTEC Head-and-Neck Tumor Study Group in all French centers practicing head-and-neck cancer surgery with reconstruction using microvascular free-flaps. The questionnaire asked surgeons about their practices regarding the use of intra- and postoperative anticoagulants and antiplatelets, preoperative management of comorbidities, and prevention of postoperative complications.
RESULTS: Sixty-one percent of the 38 respondents (23/38) used intraoperative intravenous heparin injection, associated to flap irrigation with heparin for 76% of surgeons (29/38) and/or a heparin solution bath for 37% (14/38). Postoperative anticoagulation was used by 95% of surgeons (36/38), and antiplatelets by 40% (15/38). Postoperatively, 40% (15/38) carried out monitoring using an implantable micro-Doppler probe, associated to analysis of clinical characteristics of the flap.
CONCLUSIONS: Reconstructive surgery using microvascular free-flaps involves numerous factors that can influence success. Prospective studies, particularly concerning the management of anticoagulants, could enable a national consensus on methods for free-flap reconstruction.
METHODS: A survey of practices was carried out between September 2022 and March 2023. An online questionnaire was sent to members of the French GETTEC Head-and-Neck Tumor Study Group in all French centers practicing head-and-neck cancer surgery with reconstruction using microvascular free-flaps. The questionnaire asked surgeons about their practices regarding the use of intra- and postoperative anticoagulants and antiplatelets, preoperative management of comorbidities, and prevention of postoperative complications.
RESULTS: Sixty-one percent of the 38 respondents (23/38) used intraoperative intravenous heparin injection, associated to flap irrigation with heparin for 76% of surgeons (29/38) and/or a heparin solution bath for 37% (14/38). Postoperative anticoagulation was used by 95% of surgeons (36/38), and antiplatelets by 40% (15/38). Postoperatively, 40% (15/38) carried out monitoring using an implantable micro-Doppler probe, associated to analysis of clinical characteristics of the flap.
CONCLUSIONS: Reconstructive surgery using microvascular free-flaps involves numerous factors that can influence success. Prospective studies, particularly concerning the management of anticoagulants, could enable a national consensus on methods for free-flap reconstruction.
摘要：
目的：调查头颈部肿瘤术后微血管游离皮瓣重建中抗凝血剂和抗血小板的应用。
方法：在2022年9月至2023年3月之间进行了实践调查。在线调查问卷已发送给法国GETTEC头颈部肿瘤研究小组的所有法国中心的成员，这些中心正在使用微血管游离皮瓣进行头颈部癌症手术重建。问卷询问了外科医生关于术中和术后使用抗凝剂和抗血小板的做法。合并症的术前处理，预防术后并发症。
结果：38名受访者（23/38）中有61％使用了术中静脉注射肝素，与肝素瓣冲洗相关的外科医生占76％（29/38）和/或肝素溶液浴占37％（14/38）。95％的外科医生使用了术后抗凝治疗（36/38），和抗血小板40％（15/38）。术后,40%(15/38)使用植入式微多普勒探头进行监测，分析皮瓣的临床特点。
结论：使用微血管游离皮瓣的重建手术涉及许多影响成功的因素。前瞻性研究,特别是关于抗凝剂的管理，可以就自由皮瓣重建的方法达成全国共识。
方法：在2022年9月至2023年3月之间进行了实践调查。在线调查问卷已发送给法国GETTEC头颈部肿瘤研究小组的所有法国中心的成员，这些中心正在使用微血管游离皮瓣进行头颈部癌症手术重建。问卷询问了外科医生关于术中和术后使用抗凝剂和抗血小板的做法。合并症的术前处理，预防术后并发症。
结果：38名受访者（23/38）中有61％使用了术中静脉注射肝素，与肝素瓣冲洗相关的外科医生占76％（29/38）和/或肝素溶液浴占37％（14/38）。95％的外科医生使用了术后抗凝治疗（36/38），和抗血小板40％（15/38）。术后,40%(15/38)使用植入式微多普勒探头进行监测，分析皮瓣的临床特点。
结论：使用微血管游离皮瓣的重建手术涉及许多影响成功的因素。前瞻性研究,特别是关于抗凝剂的管理，可以就自由皮瓣重建的方法达成全国共识。
