Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 Dec;40(6):600-9.
doi: 10.1111/coa.12425.

The value of postoperative anticoagulants to improve flap survival in the free radial forearm flap: a systematic review and retrospective multicentre analysis

J E Swartz  1 , M C J Aarts  1   2 , K M A Swart  1   3 , J J Disa  4 , M Gerressen  5   6 , Y-R Kuo  7 , M K Wax  8 , W Grolman  1   3 , W W Braunius  1
Affiliations
Meta-Analysis

The value of postoperative anticoagulants to improve flap survival in the free radial forearm flap: a systematic review and retrospective multicentre analysis

J E Swartz et al. Clin Otolaryngol. 2015 Dec.

Abstract

Background: Free radial forearm flap (FRFF) reconstruction is a valuable technique in head and neck surgery, which allows closure of large defects while striving to maintain functionality. Anticoagulative drugs are often administered to improve flap survival, although evidence regarding effectiveness is lacking.

Objective of review: To investigate the effectiveness of postoperative anticoagulants to improve survival of the FRFF in head and neck reconstruction.

Type of review: Systematic review and multicentre, individual patient data meta-analysis.

Search strategy: MEDLINE, EMBASE, Web of Science and CINAHL were searched for synonyms of 'anticoagulants' and 'free flap reconstruction'.

Evaluation method: Studies were critically appraised for directness of evidence and risk of bias. Authors of the highest quality publications were invited to submit their original data for meta-analysis.

Results: Five studies were of adequate quality, and data from four studies (80%) were available for meta-analysis, describing 759 FRFF procedures. Anticoagulants used were as follows: aspirin (12%), low molecular weight dextran (18.3%), unfractioned heparin (28.1%), low molecular weight heparin (49%) and prostaglandin-E1 (2.1%). Thirty-one per cent did not receive anticoagulants. Flap failure occurred in 40 of 759 patients (5.3%) On univariate analysis, use of unfractioned heparin was associated with a higher rate of flap failure. However, these regimens were often administered to patients who had revision surgery of the anastomosis. In multivariate logistic regression analysis, anticoagulant use was not associated with improved flap survival or flap-related complications.

Conclusions: The studied anticoagulative drugs did not improve FRFF survival or lower the rate of flap-related complications. In addition, some anticoagulants may cause systemic complications.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared

Figures

Figure 1
Figure 1. Flowchart
Figure 2
Figure 2. Results and meta-analysis of final flap failure
Univariate forest plot of studies that had a sufficient number of controls are shown (Riva and Lighthall,), as well as the meta-analysis of all included studies (Disa, Gerressen, Lighthall and Riva–). Limits represent 95% confidence interval. Flap failure occurred more often in patients taking heparin or LMWHs. Flap success in other treatment regimens did not differ from untreated patients.
See this image and copyright information in PMC

References

    1. Saint-Cyr M, Wong C, Buchel EW, Colohan S, Pederson WC. Free tissue transfers and replantation. Plast Reconstr Surg. 2012;130:858e–878e. - PubMed
    1. Hsiao HT, Leu YS, Lin CC. Primary closure versus radial forearm flap reconstruction after hemiglossectomy: functional assessment of swallowing and speech. Ann Plast Surg. 2002;49:612–616. - PubMed
    1. Lam L, Samman N. Speech and swallowing following tongue cancer surgery and free flap reconstruction--a systematic review. Oral Oncol. 2013;49:507–524. - PubMed
    1. Hurvitz KA, Kobayashi M, Evans GR. Current options in head and neck reconstruction. Plast Reconstr Surg. 2006;118:122e–133e. - PubMed
    1. Brands MT, van den Bosch SC, Dieleman FJ, Berge SJ, Merkx MA. Prevention of thrombosis after microvascular tissue transfer in the head and neck. A review of the literature and the state of affairs in Dutch Head and Neck Cancer Centers. Int J Oral Maxillofac Surg. 2010;39:101–106. - PubMed