Efficacy of the postoperative management after microsurgical free tissue transfer

Abstract

Introduction: The physical and medical postoperative measures after free flap reconstruction vary substantially between surgical units. The objective of this review was to identify the postoperative measures which proved a significant positive effect on free flap survival.

Method: A review was conducted in the MEDLINE database on the English and French literature.

Results and discussion: Twenty-eight articles were retained. A meta-analysis of 4984 patients who were given antithrombotics (viz. antiplatelets and anticoagulants) postoperatively found that these treatments were of no significant benefit to free flap survival and increased the risk of postoperative hematoma. Postoperative transfusions did not favor free flap survival and were associated with a higher incidence of medical complications. Preoperative anemia was a risk factor for free flap failure. Blood pressure control, vasodilators, antioxidants, corticotherapy, oxygen therapy, and prolonged immobilization were of no proven benefit.

Conclusion: No postoperative therapy, whether drug-based or not, has been shown to have a significant positive effect on free flap survival.

Keywords: Antithrombotics; Blood transfusion; Free flaps; Microsurgery.