Universität zu Köln

Torabi, Saeed ORCID: 0000-0003-0646-0465, Overbeek, Remco ORCID: 0000-0002-4046-0234, Dusse, Fabian ORCID: 0000-0001-7762-6966, Stoll, Sandra E. ORCID: 0000-0002-4803-1362, Schroeder, Carolin, Zinser, Max ORCID: 0000-0002-8017-9543 and Zirk, Matthias ORCID: 0000-0001-8776-0042 (2025). Impact of perioperative anticoagulation management on free flap survival in reconstructive surgery: a retrospective analysis. BMC Anesthesiology, 25 (1). pp. 1-9. Springer Nature. ISSN 1471-2253

PDF s12871-025-02975-6.pdf Bereitstellung unter der CC-Lizenz: Creative Commons Attribution. Download (962kB)

Abstract

Background: Despite advancements in surgical techniques and perioperative care for free flap reconstructive surgery, concerns persist regarding the risk of free flap failure, with thrombosis and bleeding being the most common complications that can lead to flap loss. While perioperative anticoagulation management is crucial for optimizing outcomes in free flap reconstructive surgery, standardized protocols remain lacking. This study aims to investigate the role of anticoagulation and perioperative practices in free flap reconstructive surgery and their impact on surgical outcomes. Methods: This retrospective, single-center study included all adult patients undergoing free flap surgery from 2009 to 2020. Patients were retrospectively divided based on intraoperative (UFH or no UFH) and postoperative anticoagulation management (UFH only, Aspirin and UFH, Aspirin only). The relationship between anticoagulation protocols, PTT values, and flap survival was assessed. Results: A total of 489 free flap surgeries were included. Most flaps were taken from the upper extremity (49.5%), primarily for tumor-related reconstructions (85.7%). Flap loss occurred in 14.5% of cases, with a median time to flap loss of 3 days post-surgery. Intraoperative UFH (20 IU/kg) was administered to 63.6% of patients and significantly predicted flap survival (OR = 0.45, 95% CI [0.24, 0.82]). PTT values on day 1 post-surgery were significantly related to flap survival (P = 0.03), with each unit increase reducing the relative probability of flap loss by 5.2%. There was no significant difference in flap survival between patients treated with heparin alone and those treated with both heparin and aspirin. The small sample size in the aspirin-only group limited the statistical relevance of this subgroup. Conclusion: Our findings highlight the importance of intraoperative UFH and PTT-guided postoperative management in improving free flap survival. Standardized anticoagulation protocols are essential for enhancing outcomes in free flap reconstructive surgery.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Torabi, Saeed UNSPECIFIED https://orcid.org/0000-0003-0646-0465 UNSPECIFIED Overbeek, Remco UNSPECIFIED https://orcid.org/0000-0002-4046-0234 UNSPECIFIED Dusse, Fabian UNSPECIFIED https://orcid.org/0000-0001-7762-6966 UNSPECIFIED Stoll, Sandra E. UNSPECIFIED https://orcid.org/0000-0002-4803-1362 UNSPECIFIED Schroeder, Carolin UNSPECIFIED UNSPECIFIED UNSPECIFIED Zinser, Max UNSPECIFIED https://orcid.org/0000-0002-8017-9543 UNSPECIFIED Zirk, Matthias UNSPECIFIED https://orcid.org/0000-0001-8776-0042 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-792947
Identification Number:	10.1186/s12871-025-02975-6
Journal or Publication Title:	BMC Anesthesiology
Volume:	25
Number:	1
Page Range:	pp. 1-9
Date:	26 February 2025
Publisher:	Springer Nature
ISSN:	1471-2253
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Anästhesiologie und Operative Intensivmedizin > Klinik für Anästhesiologie und Operative Intensivmedizin Faculty of Medicine > Zahn-, Mund- und Kieferheilkunde > Klinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie und Interdisziplinäre Klinik für Orale Chirurgie und Implantologie
Subjects:	Medical sciences Medicine
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/79294