Management of flap venous congestion: the role of heparin local subcutaneous injection

Abstract

Objective: The study aimed to propose an alternative salvage technique based on local subcutaneous injection of low molecular-weight heparin (LMWH) for the management of venous congested pedicle and free flaps in which venous outflow could not be surgically restored.

Methods: A retrospective review of all patients who received the proposed protocol at a single centre was performed.

Results: Fifteen patients were treated (six free flaps and nine regional flaps). The LMWH protocol was applied for a mean of 11 days (10-14 days). Thirteen patients required transfusions with a mean number of 5 U (0-12 U) of packed red blood cells (PRBCs) transfused per patient. All flaps were successfully salvaged (seven totally and eight partially). There were two associated complications: one patient developed a recipient-site haematoma and another patient suffered a syncope episode, related to anaemia.

Conclusions: Local subcutaneous injection of LMWH was proven to be an effective alternative in improving flap venous congestion. The main advantages of this procedure are availability, easy application and local limited action. However, the associated morbidity should be balanced against the risk of flap loss and a judicious application is mandatory.

Keywords: Flap; Heparin; Salvage therapy; Venous congestion; Venous insufficiency.