Osmotic complications of low-molecular-weight dextran therapy in free flap surgery

Low-molecular-weight dextran is utilized by many microsurgeons after free tissue transfer for its beneficial effects on the microcirculation. While it is generally felt to have a low rate of complications, severe complications secondary to dextran's osmotic effects may occur. We report here on two cases in which therapy with low-molecular-weight dextran was strongly implicated as a causative factor in major complications. These cases and their background are reviewed. Guidelines for the safe administration of this agent in patients post free-tissue transfer are discussed.