Optimizing Postoperative Anticoagulation Regimen to Improve Lower Extremity Free Flap Outcomes

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.