Venkatesh Kaushik P, Ambani Shoshana W, Arakelians Aris R L, Johnson Jonas T, Solari Mario G
Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Plastic Surgery, Henry Ford Allegiance Health System, Jackson, Michigan.
J Reconstr Microsurg. 2020 Oct;36(8):549-555. doi: 10.1055/s-0040-1710553. Epub 2020 May 14.
Patients undergoing head and neck (H&N) microvascular reconstruction comprise a population at high risk for venous thromboembolism (VTE). Free flap and VTE thromboprophylaxis may coincide but tend to vary from surgeon to surgeon. This study identifies VTE prophylaxis patterns and perceptions among H&N microsurgeons in the United States.
An online survey on VTE prophylaxis practice patterns and perceptions was emailed to 172 H&N microsurgeons in the United States using an anonymous link.
There were 74 respondents (43% response rate). These surgeons completed residencies in otolaryngology (59%), plastic surgery (31%), and oral maxillofacial surgery (7%). Most underwent fellowship training (95%) and have practiced at an academic center (97%) for at least 6 years (58%), performing an average of 42 ± 31 H&N free flap cases per year (range = 1-190). Most adhered to general VTE prophylaxis guidelines (69%) while 11% did not and 20% were unsure. Nearly all surgeons (99%) would provide prophylactic anticoagulation, mostly in the form of subcutaneous heparin (51%) or enoxaparin (44%); 64% additionally used aspirin, while 4% used aspirin alone. The majority of surgeons (68%) reported having postoperative VTE complications, with six surgeons (8%) reporting patient deaths due to pulmonary embolism. A third of the surgeons have encountered VTE prophylaxis-related adverse bleeding events, but most still believe that chemoprophylaxis is important for VTE prevention (92%). While 35% of surgeons were satisfied with their current practice, most would find it helpful to have official prophylactic anticoagulation guidelines specific to H&N free flap cases.
The majority of microsurgeons experienced postoperative VTE complications after H&N free flap reconstruction despite the routine use of prophylactic anticoagulation. Though bleeding events are a concern, most surgeons believe chemoprophylaxis is important for VTE prevention and would welcome official guidelines specific to this high-risk population.
接受头颈部（H&N）微血管重建的患者是静脉血栓栓塞（VTE）的高危人群。游离皮瓣手术与VTE预防措施可能同时进行，但不同外科医生的做法往往存在差异。本研究旨在确定美国H&N显微外科医生的VTE预防模式和看法。
通过匿名链接向美国172名H&N显微外科医生发送了一份关于VTE预防实践模式和看法的在线调查问卷。
共有74名受访者（回复率43%）。这些外科医生完成了耳鼻喉科住院医师培训（59%）、整形外科住院医师培训（31%）和口腔颌面外科住院医师培训（7%）。大多数人接受了专科培训（95%），并在学术中心工作（97%）至少6年（58%），每年平均进行42±31例H&N游离皮瓣手术（范围为1-190例）。大多数人遵循一般的VTE预防指南（69%），而11%的人不遵循，20%的人不确定。几乎所有外科医生（99%）都会提供预防性抗凝治疗，主要形式为皮下注射肝素（51%）或依诺肝素（44%）；64%的人还使用阿司匹林，4%的人仅使用阿司匹林。大多数外科医生（68%）报告有术后VTE并发症，6名外科医生（8%）报告患者因肺栓塞死亡。三分之一的外科医生遇到过与VTE预防相关的不良出血事件，但大多数人仍然认为化学预防对预防VTE很重要（92%）。虽然35%的外科医生对他们目前的做法感到满意，但大多数人认为有针对H&N游离皮瓣病例的官方预防性抗凝指南会有所帮助。
尽管常规使用预防性抗凝治疗，但大多数显微外科医生在H&N游离皮瓣重建术后仍经历了VTE并发症。虽然出血事件令人担忧，但大多数外科医生认为化学预防对预防VTE很重要，并欢迎针对这一高危人群的官方指南。
