Postoperative Antithrombotic Strategies in Head and Neck Free Flap Reconstruction: A Systematic Review and Network...

Area of Science:

• Plastic Surgery
• Vascular Surgery
• Pharmacology

Background:

• Optimal postoperative antithrombotic therapy for microvascular free flap reconstruction is debated.
• Current evidence lacks consensus on the most effective prophylactic regimen.

Purpose of the Study:

• To systematically review and compare the efficacy of various antithrombotic agents in microvascular free flap surgery.
• To determine the optimal antithrombotic regimen for reducing flap-related complications.

Main Methods:

• Systematic review and Bayesian network meta-analysis of studies from PubMed, Scopus, and Google Scholar.
• Comparison of aspirin, dextran, low-molecular-weight heparin (LMWH), unfractionated heparin (UFH), and prostaglandin E1 (PGE1) against no prophylaxis.
• Primary outcomes included flap loss, vascular complications, hematoma, and reoperation rates.

Main Results:

• Fifty-four studies involving 17,773 patients were analyzed.
• Intravenous unfractionated heparin (IV UFH) significantly increased hematoma risk (OR 4.18).
• Low-molecular-weight heparin (LMWH) showed a trend towards increased reoperation rates (OR 2.25).
• No antithrombotic regimen consistently reduced flap loss or thrombosis compared to no prophylaxis.

Conclusions:

• Antithrombotic agents demonstrated minimal efficacy in preventing flap-related complications.
• Findings suggest that individualized prophylaxis strategies are warranted.
• Further prospective studies are crucial for developing evidence-based guidelines for antithrombotic use.