Intravascular heparin perfusion prior to microvascular anastomosis in head and neck free flap reconstruction: A...

Intravascular heparin irrigation is commonly used during microvascular anastomosis in free flap surgery. However, conventional techniques typically involve brief luminal flushing without confirmation of downstream microcirculatory clearance. We implemented a structured intravascular perfusion protocol to facilitate controlled intra-flap circulation prior to anastomosis and evaluated its feasibility and clinical outcomes compared with conventional heparin flushing in head and neck free flap reconstruction.

This retrospective comparative cohort study included adult patients undergoing head and neck free flap reconstruction at a tertiary center. Patients were grouped by pedicle preparation technique: conventional flushing (January 2016-February 2020) and heparin intravascular perfusion (HIP; March 2020-December 2024). The HIP technique involved arterial cannulation and controlled pulsatile perfusion of heparinized saline until venous efflux was observed. Primary outcomes were flap survival, venous thrombosis, and re-exploration.

A total of 123 patients were included (60 conventional, 63 HIP). Baseline characteristics were comparable. Flap survival was 95.0% in the conventional group and 98.4% in the HIP group. Re-exploration rates were 11.6% and 3.2%, respectively. Venous thrombosis occurred in 6.7% of conventional cases and 3.2% of HIP cases. No total flap loss occurred in the HIP group, whereas three cases occurred in the conventional group, all in salvage reconstructions. No increase in bleeding complications was observed.

Structured intravascular heparin perfusion was associated with lower rates of venous thrombosis and re-exploration without increased bleeding. This technique may serve as a feasible adjunct for vascular pedicle preparation in head and neck free flap reconstruction.