Could Lipo-Prostaglandin E1 Be the Key to Improving Success Rates in Free-Flap Microsurgery? A Systematic Review

Background: Microsurgery and free tissue transfer with microanastomoses are common practices that are reliable for restoring anatomical function and/or morphology. Maintaining adequate blood flow to transferred tissue and preventing thrombosis are key challenges in improving the success of surgery. We conducted a systematic review to investigate the use, effects, and efficacy of lipo-prostaglandin E1 (lipo-PGE1) and PGE1, which have vasodilatory and anticoagulation effects, in microsurgery. Methods: Studies were reviewed for information about the administration of lipo-PGE1/PGE1, including the purpose, effectiveness, administered doses, and duration of use. This review included articles published up to 2024. Databases: PubMed, MEDLINE, and Embase were searched using the keywords: "flap" AND "prostaglandin E1" and "microsurgery" AND "prostaglandin E1." Results: The initial database search yielded 359 citations; 14 were included in our study with qualitative analysis. These 14 original articles reported PGE1/lipo-PGE1 use in microsurgery for the reconstruction of different anatomical sites, with the most common being the head and neck. Twenty-one different flaps were used; the most common flaps used in head, neck, and lower limb reconstructions were anterolateral thigh flaps. Most studies reported using PGE1/lipo-PGE1 as an antithrombotic, an anticoagulant, a vasodilator, and a strategy to examine blood flow post administration. Only one study compared its effectiveness between two groups and showed significantly lower perfusion-related complications in the prostaglandin group than in the control group. Conclusions: Lipo-PGE1/PGE1 has potential vasodilator effects that increase blood flow through free flaps and potential anticoagulant properties that help prevent thrombosis in microanastomoses. However, multicenter, randomized controlled studies are needed to fully elucidate its benefits.