Is Routine Anticoagulation Warranted Following Free Flap Reconstruction?

Abstract

Microvascular free flap reconstruction is a mainstay of reconstruction of complex head and neck defects. Given the devastating, albeit rare, consequences of thrombus formation which can lead to flap loss, most free flap surgeons report use of some form of chemoprophylaxis preoperatively. However, despite widespread use of perioperative chemoprophylaxis in free flap patients, no single regimen has been shown to be superior, and thus no consensus exists on optimal management in this regard. This article examines the literature on postoperative anticoagulation in head and neck microvascular surgery, with a focus on three of the most commonly used agents: heparin, aspirin, and dextran. Herein we demonstrate relatively strong evidence against the use of Dextran based given lack of benefit and risk of adverse event. The data on aspirin and prophylactic dosing of heparin are less clear, with insufficient evidence to recommend for or against their use. However, given that these medications are well tolerated, and given the additional protective effect against venous thromboembolism (VTE) in a generally high risk population, the senior author routinely uses these medications postoperatively following microvascular surgery.