Abstract：
OBJECTIVE: Free tissue transfer has an established place in oncologic head and neck surgery. However, the necessity and specific regimen of perioperative thromboprophylaxis remain controversial. Here, the risk of postoperative hemorrhage contrasts with vascular pedicle thrombosis and graft loss. This work compares three different heparin protocols (A-C) with regard to postoperative complications.
METHODS: A retrospective analysis of our free flap transplants between 2004 and 2023 was conducted. Inclusion criteria were thromboprophylaxis with (A) 500 IU/h unfractionated heparin (UFH), (B) low-molecular-weight heparin (LMWH) once daily, and (C) LMWH once daily with additional immediate preoperative administration. Primary endpoints were the incidence of postoperative bleeding and hematoma and the appearance of flap thrombosis.
RESULTS: We evaluated 355 cases, 87 in group A, 179 in group B, and in group C 89 patients. Overall, postoperative bleeding occurred in 8.7% of patients, and 83% underwent hemostasis under intubation anesthesia, with no significant difference between groups (p = 0.784). Hematoma formation requiring revision was found in 3.7% of patients (p = 0.660). We identified postoperative hematoma as a significant influencing factor for venous pedicle thrombosis (OR 3.602; p = 0.001). Venous and arterial flap thrombosis in the graft vessel showed no difference between the groups (p = 0.745 and p = 0.128).
CONCLUSIONS: The three anticoagulation regimens appear to be equivalent therapy for the prevention of thrombosis without significant differences in postoperative bleeding. The use of LMWH with additional preoperative administration can, therefore, be administered in free flap reconstruction.
METHODS: A retrospective analysis of our free flap transplants between 2004 and 2023 was conducted. Inclusion criteria were thromboprophylaxis with (A) 500 IU/h unfractionated heparin (UFH), (B) low-molecular-weight heparin (LMWH) once daily, and (C) LMWH once daily with additional immediate preoperative administration. Primary endpoints were the incidence of postoperative bleeding and hematoma and the appearance of flap thrombosis.
RESULTS: We evaluated 355 cases, 87 in group A, 179 in group B, and in group C 89 patients. Overall, postoperative bleeding occurred in 8.7% of patients, and 83% underwent hemostasis under intubation anesthesia, with no significant difference between groups (p = 0.784). Hematoma formation requiring revision was found in 3.7% of patients (p = 0.660). We identified postoperative hematoma as a significant influencing factor for venous pedicle thrombosis (OR 3.602; p = 0.001). Venous and arterial flap thrombosis in the graft vessel showed no difference between the groups (p = 0.745 and p = 0.128).
CONCLUSIONS: The three anticoagulation regimens appear to be equivalent therapy for the prevention of thrombosis without significant differences in postoperative bleeding. The use of LMWH with additional preoperative administration can, therefore, be administered in free flap reconstruction.
摘要：
目的：游离组织移植在肿瘤头颈部手术中占有重要地位。然而,围手术期血栓预防的必要性和具体方案仍存在争议.这里,术后出血的风险与血管蒂血栓形成和移植物丢失形成对比.这项工作比较了三种不同的肝素方案（A-C）关于术后并发症。
方法：对我们在2004年至2023年之间的游离皮瓣移植进行了回顾性分析。纳入标准是使用（A）500IU/h普通肝素（UFH）进行血栓预防，(B)低分子量肝素(LMWH)每日一次,和(C)LMWH,每日一次,额外的术前立即给药。主要终点是术后出血和血肿的发生率以及皮瓣血栓形成的出现。
结果：我们评估了355例，87在A组中，B组179,C组89例。总的来说,8.7%的患者发生术后出血,83%在插管麻醉下止血，组间无显著差异(p=0.784)。在3.7％的患者中发现需要修正的血肿形成（p=0.660）。我们确定术后血肿是静脉蒂血栓形成的重要影响因素（OR3.602；p=0.001）。移植血管中的静脉和动脉皮瓣血栓形成在两组之间没有差异（p=0.745和p=0.128）。
结论：三种抗凝治疗方案似乎是预防血栓形成的等效治疗方法，但术后出血无显著差异。使用LMWH和额外的术前给药可以，因此,在游离皮瓣重建中给予。
方法：对我们在2004年至2023年之间的游离皮瓣移植进行了回顾性分析。纳入标准是使用（A）500IU/h普通肝素（UFH）进行血栓预防，(B)低分子量肝素(LMWH)每日一次,和(C)LMWH,每日一次,额外的术前立即给药。主要终点是术后出血和血肿的发生率以及皮瓣血栓形成的出现。
结果：我们评估了355例，87在A组中，B组179,C组89例。总的来说,8.7%的患者发生术后出血,83%在插管麻醉下止血，组间无显著差异(p=0.784)。在3.7％的患者中发现需要修正的血肿形成（p=0.660）。我们确定术后血肿是静脉蒂血栓形成的重要影响因素（OR3.602；p=0.001）。移植血管中的静脉和动脉皮瓣血栓形成在两组之间没有差异（p=0.745和p=0.128）。
结论：三种抗凝治疗方案似乎是预防血栓形成的等效治疗方法，但术后出血无显著差异。使用LMWH和额外的术前给药可以，因此,在游离皮瓣重建中给予。
