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Review
. 2018 Jun;11(2):85-95.
doi: 10.1055/s-0037-1607068. Epub 2017 Oct 31.

Thromboprophylaxis in Head and Neck Microvascular Reconstruction

Manoj Abraham  1 , Arvind Badhey  2 , Shirley Hu  2 , Sameep Kadakia  2 , J K Rasamny  1 , Augustine Moscatello  1 , Yadranko Ducic  3
Affiliations
Review

Thromboprophylaxis in Head and Neck Microvascular Reconstruction

Manoj Abraham et al. Craniomaxillofac Trauma Reconstr. 2018 Jun.

Abstract

Head and neck patients undergoing microvascular reconstruction are at high risk for thromboembolism. While the prevention of thromboembolism has become an essential aspect of care, within the field of microsurgery, concern for anastomotic complications have hindered the creation of an accepted regimen. The aim of this review was to evaluate the risks and benefits of prophylactic agents for thromboprophylaxis. A literature search was conducted in MEDLINE, Cochrane Library, and PubMed/NCBI databases. Articles discussing thromboprophylaxis in otolaryngology, head and neck surgery, or microvascular reconstruction were considered in the review from the past 30 years. The majority of patients undergoing microvascular surgery have multiple risk factors for thrombus formation. Several consensus guidelines exist for the prophylaxis in patients who are critically ill, undergoing surgery, or with malignancy. Significant evidence supports the routine use of mechanical means, such as early mobilization and pneumatic compression along with subcutaneous heparin. Low-molecular-weight heparin is also frequently utilized, although results are largely divided. Data on aspirin remain equivocal. Studies on microvascular failure and flap loss have demonstrated little to no association with chemoprophylaxis. The evidence for postoperative thromboprophylaxis regimens in patients undergoing head and neck free tissue transfer is variable. Multiple studies have supported the use of unfractionated heparin or low-molecular-weight heparin. There appears to be an expert consensus for the combined use of mechanical prophylactic methods and chemical prophylaxis. Prospective randomized trials are required to validate the most effective combination of chemoprophylaxis agents.

Keywords: anticoagulation; head and neck surgery; microvascular surgery; thromboprophylaxis.

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Conflict of interest statement

Conflict of Interest This article has not been/nor is being considered for publication elsewhere. There are no financial disclosures or conflicts of interest.

Figures

Fig. 1
Fig. 1
Schematic of the coagulation cascade and target areas of chemoprophylactic agents. (We thank Jill Gregory for providing this artwork. This piece has been used with permission from the Mount Sinai Health System).
See this image and copyright information in PMC

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