Assessing current applications of tranexamic acid in reconstructive microsurgery and future direction: An 11-year...

Area of Science:

• Plastic Surgery
• Microsurgery
• Pharmacology

Background:

• Tranexamic acid (TXA) use is growing in plastic surgery for its anti-inflammatory benefits, particularly reducing seromas.
• Concerns regarding microvascular thrombosis limit TXA's application in reconstructive microsurgery.
• This study systematically reviews TXA's efficacy and safety in microsurgical procedures.

Purpose of the Study:

• To evaluate the clinical outcomes of tranexamic acid (TXA) in reconstructive microsurgery.
• To assess the impact of TXA on postoperative complications, including flap compromise and thrombosis.
• To determine the safety profile of TXA in microsurgical applications.

Main Methods:

• Systematic review and meta-analysis of studies from 2013-2023.
• Searched major databases (PubMed, Cochrane, Embase, Google Scholar) following PRISMA guidelines.
• Assessed study bias using ROBINS-I; meta-analysis calculated weighted relative risk (wRR) for complications.

Main Results:

• Analysis of 718 patients and 854 flaps revealed no increased risk of flap loss or thrombosis with intravenous (IV) TXA.
• Topical TXA significantly reduced donor site complications (RR, 0.52) and shortened drain duration by 7.5 days.
• No significant increase in systemic thromboembolic events was observed with IV TXA.

Conclusions:

• TXA is safe in microsurgery, decreasing donor site issues without raising flap or systemic complication risks.
• TXA's anti-inflammatory properties may promote wound healing.
• Further randomized controlled trials are recommended to establish standardized TXA protocols for microsurgery.