PO-62 - Remote ischemic preconditioning in head and neck cancer reconstruction - a randomized controlled trial

In reconstructive head and neck cancer surgery, tissue flaps are transferred to the surgical defect and revascularized by anastomosis of small vessels. Cancer patients are in a hypercoagulable state with high risk of peri- and postoperative thrombotic events. Thrombosis to the tissue flap anastomoses or microcirculation is the main reason for total flap necrosis with potential fatal consequences for the patient. Remote ischemic preconditioning (RIPC), where brief cycles of upper extremity ischemia are induced with an inflatable tourniquet, triggers a global protection of tissues subjected to ischemia-reperfusion injury. RIPC has also been shown to impact the coagulation system.

The aim of the trial is to investigate, if RIPC attenuates platelet aggregation during reconstructive head and neck cancer surgery.

Sixty patients with head and neck cancer will be included in the trial. The subjects will be randomized to RIPC or sham during surgery. RIPC is administered by four 5-minute cycles of upper extremity ischemia, each separated by five minutes of reperfusion. Blood samples will be drawn preoperatively, before RIPC/sham, 3 hours after RIPC/ sham, 6 hours after RIPC/sham, and on the first postoperative day. Platelet aggregation will be measured with the Multiplate® analyzer using collagen, ADP and TRAP as agonists. Furthermore, platelet count, mean platelet volume, immature platelet fraction, and von Willebrand factor antigen are determined.

The trial is ongoing. Preliminary results will be presented at ICTHIC 2016.

If RIPC proves to attenuate platelet aggregation, it could become a novel antithrombotic treatment in oncologic reconstructive surgery. Hence, morbidity and mortality related to surgery is reduced, and adjuvant oncologic therapy can be initiated in timely fashion.