Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB.
J Otolaryngol Head Neck Surg. 2011 Feb;40 Suppl 1:S59-64.
Free flaps have become the mainstay of reconstruction after resection of head and neck cancer. Thrombosis after microvascular reanastamosis is a common reason for free flap failure. Various anticoagulants have been used topically and systemically to prevent thrombosis. Tirofiban is a glycoprotein IIb/IIIa inhibitor that prevents platelet aggregation and helps prevent thrombosis. The purpose of this study was to compare the thrombosis rate of topical heparin to topical heparin + tirofiban in a thrombogenic free flap model in rats.
Prospective, randomized, double-blind, controlled trial.
A thrombogenic free flap model was developed by raising a fasciocutaneous flap based on the epigastric artery in the Sprague-Dawley rat. An intimal flap was created proximal to the anastomosis site to increase thrombosis rates. Eighty rats were randomized to this thrombogenic free flap model using topical saline, heparin, or topical heparin + tirofiban. Each free flap was assessed for skin necrosis, capillary refill, and vessel thrombosis at 48 hours postprocedure. Data for each group were collected in a double-blind fashion.
The heparin + tirofiban group had a 23% lower thrombosis rate and hence free flap failure rate when compared to the heparin alone group (p = .044).
The use of topical tirofiban in addition to topical heparin in microvascular surgery results in reduced rates of thrombosis and should be considered for use in head and neck oncology patients undergoing free flap reconstruction.
游离皮瓣已成为头颈部癌切除后重建的主要手段。微血管再吻合后的血栓形成是游离皮瓣失败的常见原因。各种抗凝剂已被用于局部和全身以预防血栓形成。替罗非班是一种糖蛋白 IIb/IIIa 抑制剂，可防止血小板聚集并有助于预防血栓形成。本研究旨在比较局部肝素与局部肝素+替罗非班在大鼠血栓形成游离皮瓣模型中的血栓形成率。
前瞻性、随机、双盲、对照试验。
通过在 Sprague-Dawley 大鼠的腹上动脉上掀起筋膜皮瓣，建立血栓形成的游离皮瓣模型。在吻合部位近端创建一个内膜瓣，以增加血栓形成率。80 只大鼠随机分为血栓形成的游离皮瓣模型，分别使用局部生理盐水、肝素或局部肝素+替罗非班。在术后 48 小时，每个游离皮瓣均评估皮肤坏死、毛细血管再充盈和血管血栓形成情况。每个组的数据均以双盲方式收集。
与单独使用肝素组相比，肝素+替罗非班组的血栓形成率（即游离皮瓣失败率）降低了 23%（p=0.044）。
在微血管手术中局部使用替罗非班加用局部肝素可降低血栓形成率，应考虑在头颈部肿瘤患者行游离皮瓣重建时使用。
