Perioperative Hypercoagulability in Free Flap Reconstructions Performed for Intracranial Tumors

Area of Science:

• Neurosurgery
• Plastic Surgery
• Vascular Surgery

Background:

• Patients with intracranial tumors present an elevated risk for thromboembolic events, particularly during surgical intervention.
• An anecdotal rise in perioperative flap thrombosis during free tissue transfer for intracranial tumor resection has been observed.

Purpose of the Study:

• To formally assess the risk of perioperative flap thrombosis in patients undergoing free tissue transfer for intracranial tumor resection.
• To evaluate the impact of anticoagulation on flap outcomes in this patient population.

Main Methods:

• A multi-institutional retrospective chart review was conducted.
• Patients undergoing free tissue transfer for scalp/cranial reconstruction were analyzed for perioperative thrombosis and free flap outcomes.

Main Results:

• The study included 209 patients undergoing 246 free tissue transfers.
• A significantly higher incidence of perioperative flap thrombosis was observed in the intracranial tumor group (39%) compared to controls (19%) (p=0.0287).
• Therapeutic anticoagulation was associated with a reduced risk of flap failure, though not statistically significant (p=0.148). Flap survival rates were comparable between groups (93.3% vs. 95%).

Conclusions:

• Patients with intracranial tumors undergoing free tissue scalp reconstruction exhibit an increased risk of perioperative flap thrombosis.
• Anticoagulation appears to be a potential mitigating factor for this increased risk.