Torabi Saeed, Overbeek Remco, Dusse Fabian, Stoll Sandra E, Schroeder Carolin, Zinser Max, Zirk Matthias
Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
Department for Oral and Craniomaxillofacial and Plastic Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
BMC Anesthesiol. 2025 Feb 26;25(1):106. doi: 10.1186/s12871-025-02975-6.
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.
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.
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.
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.
尽管游离皮瓣重建手术的外科技术和围手术期护理取得了进展，但对于游离皮瓣失败的风险仍存在担忧，血栓形成和出血是导致皮瓣丢失的最常见并发症。虽然围手术期抗凝管理对于优化游离皮瓣重建手术的结果至关重要，但仍缺乏标准化方案。本研究旨在探讨抗凝和围手术期措施在游离皮瓣重建手术中的作用及其对手术结果的影响。
这项回顾性单中心研究纳入了2009年至2020年期间所有接受游离皮瓣手术的成年患者。根据术中（使用普通肝素或未使用）和术后抗凝管理（仅使用普通肝素、阿司匹林和普通肝素、仅使用阿司匹林）对患者进行回顾性分组。评估抗凝方案、活化部分凝血活酶时间（PTT）值与皮瓣存活之间的关系。
共纳入489例游离皮瓣手术。大多数皮瓣取自上肢（49.5%），主要用于肿瘤相关重建（85.7%）。14.5%的病例发生皮瓣丢失，皮瓣丢失的中位时间为术后3天。63.6%的患者术中使用了普通肝素（20 IU/kg），这显著预测了皮瓣存活（比值比=0.45，95%置信区间[0.24，0.82]）。术后第1天的PTT值与皮瓣存活显著相关（P=0.03），每增加一个单位，皮瓣丢失的相对概率降低5.2%。单独使用肝素治疗的患者与同时使用肝素和阿司匹林治疗的患者之间皮瓣存活无显著差异。仅使用阿司匹林组的样本量较小，限制了该亚组的统计学相关性。
我们的研究结果强调了术中使用普通肝素和PTT指导的术后管理对提高游离皮瓣存活的重要性。标准化抗凝方案对于改善游离皮瓣重建手术的结果至关重要。
