Thromboprophylaxis in Head and Neck Microvascular Reconstruction

Area of Science:

• Surgical Oncology
• Vascular Surgery
• Thrombosis Research

Background:

• Head and neck cancer patients undergoing microvascular reconstruction are at significant risk for thromboembolism.
• Existing thromboprophylaxis regimens are not universally accepted due to concerns about anastomotic complications.

Purpose of the Study:

• To review the risks and benefits of prophylactic agents for thromboprophylaxis in head and neck microvascular reconstruction.
• To evaluate current evidence supporting thromboprophylaxis strategies in this patient population.

Main Methods:

• A comprehensive literature search was performed in MEDLINE, Cochrane Library, and PubMed/NCBI databases.
• Articles published within the last 30 years focusing on thromboprophylaxis in head and neck surgery and microvascular reconstruction were included.

Main Results:

• Mechanical prophylaxis (early mobilization, pneumatic compression) combined with subcutaneous heparin shows strong support.
• Low-molecular-weight heparin has divided results, and aspirin data remain equivocal.
• Limited association found between chemoprophylaxis and microvascular failure or flap loss.

Conclusions:

• An expert consensus supports combining mechanical prophylactic methods with chemical prophylaxis.
• Evidence for specific postoperative thromboprophylaxis regimens in head and neck free tissue transfer is variable.
• Prospective randomized trials are necessary to establish the most effective chemoprophylaxis combinations.