Head and Neck Free-Flap Reconstruction in Patients With Pre-Existing Coagulopathies: A Case Series

Area of Science:

• Plastic Surgery
• Hematology
• Vascular Surgery

Background:

• Patients with inherited coagulopathies, including thrombophilias, face increased thrombotic risks during microvascular reconstruction.
• Optimal perioperative management strategies for these patients remain undefined.

Purpose of the Study:

• To evaluate perioperative outcomes in patients with inherited coagulopathies undergoing head and neck free flap reconstruction.
• To assess the impact of anticoagulation strategies on thrombotic complications.

Main Methods:

• Retrospective case series of 15 patients with confirmed inherited coagulopathies undergoing head and neck free flap reconstruction.
• Analysis of preoperative, intraoperative, and postoperative anticoagulation regimens.
• Evaluation of flap outcomes, thrombotic events, and bleeding complications.

Main Results:

• The most common coagulopathies were sickle cell trait (40.0%) and Factor V Leiden (26.7%).
• Two patients (13.3%) experienced flap loss due to thrombosis; neither received intraoperative anticoagulation.
• No major bleeding events occurred; 40.0% required postoperative transfusions.

Conclusions:

• Targeted screening, multidisciplinary coordination, and individualized anticoagulation are essential to mitigate thrombotic complications.
• Further prospective studies are needed to develop standardized perioperative protocols for this high-risk population.