Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Int J Oral Maxillofac Surg. 2010 Feb;39(2):101-6. doi: 10.1016/j.ijom.2009.11.020. Epub 2009 Dec 29.
Free vascularized graft or free-flap reconstruction is frequently used in the reconstruction of defects in head and neck oncology patients. A common complication in free-flap surgery is thrombosis. Thrombosis occurs in 8-14% of cases and often leads to flap failure. A review of the literature on this subject was carried out and Dutch head and neck cancer centres were asked to share their guidelines concerning the prevention of thrombosis after free vascularized graft surgery. No consensus in the literature was found on how thrombosis could best be prevented. The Dutch Head and Neck Cancer Centers use routine deep venous thrombosis prophylaxis to prevent thrombosis in the anastomosis. It was also concluded that non-pharmacologic measures for preventing thrombosis, such as meticulous microvascular surgery and smoking cessation prior to the operation, are thought to play an important role in the prevention of thrombosis in microvascular free-flap reconstructions. It has not been determined which pre- and postoperative pharmacologic measure can prevent thrombosis most effectively. A pharmacologic regimen to prevent thrombosis that is customized to the patient is suggested. This should be based on an individual risk profile for the development of thrombosis.
游离血管化移植物或游离皮瓣重建常用于头颈部肿瘤患者的缺损重建。游离皮瓣手术的常见并发症是血栓形成。血栓形成发生在 8-14%的病例中，常导致皮瓣失败。对这一主题的文献进行了回顾，并要求荷兰头颈部癌症中心分享他们关于游离血管化移植物手术后预防血栓形成的指南。文献中没有发现关于如何最好地预防血栓形成的共识。荷兰头颈部癌症中心使用常规深静脉血栓形成预防来预防吻合处的血栓形成。还得出结论，预防血栓形成的非药物措施，如在手术前进行精细的微血管手术和戒烟，被认为在预防微血管游离皮瓣重建中的血栓形成中发挥重要作用。尚未确定哪种术前和术后药物措施能最有效地预防血栓形成。建议根据患者的个体血栓形成风险概况制定预防血栓形成的药物方案。
