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Related Experiment Video

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A Model of Free Tissue Transfer: The Rat Epigastric Free Flap
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Thromboelastometry: A contribution to perioperative free-flap management.

Johannes Wikner1, Benedicta E Beck-Broichsitter1, Saskia Schlesinger2

  • 1Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Germany.

Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery
|July 2, 2015
PubMed
Summary

Thromboelastometry can monitor real-time hemostatic changes during free flap surgery. While it shows promise as a supplementary tool for assessing individual anticoagulation needs, further validation is required.

Keywords:
AnticoagulationFree flap surgeryHeparinMicrosurgeryThromboelastometry

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Area of Science:

  • Vascular Surgery
  • Anesthesiology
  • Hematology

Background:

  • Microvascular tissue transfer is crucial in reconstructive surgery, with anticoagulation regimens impacting outcomes.
  • Bleeding and thrombosis are significant causes of revision and flap loss, necessitating improved anticoagulative strategies.
  • Thromboelastometry (TEM) is a valuable tool for assessing coagulation cascade alterations.

Purpose of the Study:

  • To evaluate the utility of thromboelastometry in monitoring perioperative hemostatic changes during free flap surgery.
  • To assess the impact of heparin therapy on coagulation parameters using TEM.
  • To compare TEM with standard testing for predicting adverse events.

Main Methods:

  • Thirty-five patients undergoing free flap surgery were included.
  • Blood samples were analyzed using thromboelastometry at three perioperative time points.
  • Global coagulation markers and clinical data were collected concurrently.

Main Results:

  • Thromboelastometry effectively detected perioperative hemostatic changes, with significant temporal variations (p < 0.05).
  • Heparin therapy significantly affected INTEM clotting times (p < 0.001).
  • Neither TEM nor standard tests predicted adverse events like thrombosis or flap loss (p > 0.05).

Conclusions:

  • Thromboelastometry offers near real-time monitoring of hemostasis in microvascular surgery.
  • TEM can aid in tailoring anticoagulation for individual patients undergoing free flap procedures.
  • Further validation of thromboelastometry in free flap surgery is recommended.