Comparison of anticoagulant prophylaxis protocols in microvascular head and neck reconstruction in the Department of maxillofacial surgery

Prijenos slobodnih režnjeva sastavni je dio rekonstruktivne kirurgije glave i vrata. Usavršena tehnika mikrovaskularne anastomoze i sve veće iskustvo mikrokirurga utjecali su na smanjenje stope propadanja režnja. Ipak, kako bi se spriječilo formiranje tromba i posljedični gubitak režnja, mnogi kirurzi koriste farmakološka antitrombotska sredstva kao što su dekstran 40 i niskomolekularni heparin, premda je učinkovitost tih lijekova upitna. Cilj ovog istraživanja je usporediti dva protokola antikoagulantne profilakse u smislu učinkovitosti na preživljavanje prenesenog slobodnog režnja. U ovoj retrospektivnoj analizi identificirano je 176 uzastopnih operacija slobodnih režnjeva u Klinici za kirurgiju lica, čeljusti i usta tijekom četverogodišnjeg razdoblja. Usporedba je provedena između dvije grupe pacijenata, u Grupi 1 (98 pacijenata) upotrebljavao se dekstran 40, dok se u Grupi 2 (78 pacijenata) on nije koristio. U obje skupine primjenjivan je niskomolekularni heparin u profilaksi duboke venske tromboze do mobilizacije bolesnika. Primarni ishod istraživanja utvrđen je kao broj propalih slobodnih režnjeva, a sekundarni kao broj slučajeva arterijske i venske tromboze te krvarenja. U svrhu praćenja sigurnosti terapije dekstranom 40, uspoređena je i incidencija lokalnih i sistemskih komplikacija. Demografska analiza nije pokazala statistički značajne razlike između dvije skupine. Srednja dob u cijelom uzorku iznosila je 59.9 godina, s time da su žene činile 1/3 pacijenata. Ukupna stopa preživljavanja režnjeva bila je 90.34%. Bilo je 16 propalih režnjeva i 1 parcijalni gubitak. Revizija anastomoze bila je potrebna u 27 slučajeva, od čega je 17 spašeno. Nije bilo statistički značajne razlike u incidenciji gubitka slobodnih režnjeva i drugih komplikacija između skupina. Zaključili smo da u postoperativnom razdoblju dekstran 40 nije učinkovit kao sredstvo antikoagulantne profilakse u rekonstrukciji glave i vrata tehnikom prijenosa slobodnih režnjeva.Free tissue transfer is an integral part of reconstructive head and neck surgery. Increased experience and refinements in the technique of microvascular anastomosis have minimized flap loss. However, pharmacological antithrombotic agents such as dextran 40 and low-molecular-weight heparin have been used to prevent thrombus formation and flap failures, even though the effectiveness of these drugs has been questioned in recent literature. The aim of this study is to compare two anticoagulant prophylaxis protocols in terms of efficacy on flap survival. It is a retrospective analysis of 176 consecutive flaps performed at the Department of Maxillofacial Surgery during a 4-year period. A comparison was made between two patient groups, based on postoperative anticoagulation administration. Group 1 included 98 patients and was treated with dextran 40, while Group 2 consisted of 78 patients and did not receive dextran 40. In both groups low-molecular-weight heparin was administered until ambulation. Primary outcome of the study was determined as flap loss rate, while secondary outcome as the rate of arterial and venous thrombosis or hemorrhage. In terms of safety, the incidence of local and systemic complications was also compared. Demographic analysis did not show any statistically significant difference between the two groups. Mean age of both groups was 59.9 years, while women made up for 1/3 of the patients. Total flap survival rate was 90.34%. There were 16 free flap losses and 1 partial loss. Anastomoses were reexplored in 27 cases and 17 were salvaged. There were no statistically significant differences among groups in the incidence of neither free flap loss nor other complications. We concluded that dextran 40 is not effective as an anticoagulant agent in the postoperative period in head and neck reconstruction with free tissue transfer