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Optimizing Postoperative Anticoagulation Regimen to Improve Lower Extremity Free Flap Outcomes.

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Postoperative anticoagulation and antiplatelet regimens did not significantly impact lower extremity free flap success. Further randomized trials are needed to establish optimal protocols for these complex reconstructions.

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Area of Science:

  • Orthopedic Surgery
  • Vascular Surgery
  • Plastic Surgery

Background:

  • Free flap reconstruction for lower extremity (LE) trauma has a higher failure rate compared to other regions.
  • Optimal postoperative anticoagulation and antiplatelet therapy for LE free flaps remains undefined.
  • Current protocols are based on surgeon discretion, introducing potential bias.

Purpose of the Study:

  • To evaluate complication rates associated with different anticoagulation and antiplatelet protocols in LE free flap reconstruction.
  • To identify the most effective postoperative regimen for improving outcomes in LE free flap surgery.

Main Methods:

  • Retrospective chart review of adult patients undergoing LE free flap reconstruction from 2016-2021.
  • Patients were categorized into three groups: aspirin only, heparin only, or aspirin + heparin.
  • Major complications (hematoma, thrombosis, necrosis, infection) requiring reoperation were analyzed.

Main Results:

  • Of 191 patients, 37 received aspirin, 76 received heparin, and 78 received aspirin + heparin.
  • Univariate analysis showed a lower complication rate in the heparin-only group (5.26%) compared to aspirin-only (18.92%) and aspirin + heparin (20.51%).
  • Multivariate analysis, however, found no significant association between the anticoagulation group and major complications.

Conclusions:

  • No specific anticoagulation or antiplatelet regimen (aspirin alone, heparin alone, or combination) demonstrated a superior association with favorable LE free flap outcomes.
  • The retrospective nature and surgeon discretion in protocol selection limit definitive conclusions.
  • Randomized controlled trials with standardized postoperative regimens are recommended to definitively assess complication differences.