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
. 2025 Mar;45(3):e70046.
doi: 10.1002/micr.70046.

Use of Tranexamic Acid in Head and Neck Free Flap Reconstruction

Fuat B Bengur  1 , Micah K Harris  2 , Michael S Hu  1 , Rula Mualla  2 , Arash Samadi  1 , Olivier Bourguillon  2 , Joshua Smith  2 , Vu T Nguyen  1 , Michael L Gimbel  1 , Kevin Contrera  2 , Matthew Spector  2 , Mario G Solari  1 , Mark W Kubik  2 , Shaum S Sridharan  2
Affiliations

Use of Tranexamic Acid in Head and Neck Free Flap Reconstruction

Fuat B Bengur et al. Microsurgery. 2025 Mar.

Abstract

Introduction: Tranexamic acid (TXA) is commonly used in surgical settings to reduce blood loss. Due to its antifibrinolytic properties, TXA theoretically increases the risk of thrombosis. In this study, the use of TXA was assessed in patients undergoing head and neck free flap reconstruction.

Methods: A cohort of patients from February 2021 to September 2023 received TXA. Patients received 3 g of intravenous TXA intraoperatively, in addition to topical TXA to the donor, recipient, and neck dissection sites. Patients were compared to a retrospective cohort from August 2019 to January 2021. All patients, including those in the retrospective control cohort, met the criteria for TXA.

Results: A total of 397 patients underwent free flap reconstruction (53.6% thigh, 25.6% fibula), of which 185 received TXA and 212 did not. Patients receiving the TXA protocol had a lower perioperative transfusion rate (12.9% vs. 20.7%, p = 0.042) and intraoperative estimated blood loss (196.4 ± 102.9 cc vs. 263.7 ± 247.8 cc, p < 0.001). There was no difference in postoperative flap vascular compromise in the TXA (7.6%) versus control (10.4%) groups (p = 0.33). Postoperative complications, including hematoma and thromboembolic events, were not statistically different between the groups. On multivariate analysis, the use of TXA remained predictive of reduced perioperative transfusion when controlling for BMI > 25, osseous flap, and hypertension.

Conclusion: Patients who received TXA demonstrated decreased perioperative transfusion after head and neck free flap reconstruction with no increase in flap vascular compromise or major thromboembolic events. Implementation of our protocol to larger cohorts and randomized controlled trials could help identify an optimal dosing regimen and demonstrate long-term efficacy.

Keywords: free flap; head and neck; tranexamic acid.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Schematic of the developed tranexamic acid protocol.
FIGURE 2
FIGURE 2
Schematic of the study protocol.
See this image and copyright information in PMC

References

    1. Alsubaie, H. M. , Abu‐Zaid A., Sayed S. I., et al. 2022. “Tranexamic Acid in Head and Neck Procedures: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials.” European Archives of Oto‐Rhino‐Laryngology 279, no. 5: 2231–2238. 10.1007/s00405-021-07132-6. - DOI - PubMed
    1. Boucher, B. A. , and Traub O.. 2009. “Achieving Hemostasis in the Surgical Field.” Pharmacotherapy 29, no. 7: 2S–7S. 10.1592/phco.29.pt2.2S. - DOI - PubMed
    1. Brown, S. , Yao A., and Taub P. J.. 2018. “Antifibrinolytic Agents in Plastic Surgery: Current Practices and Future Directions.” Plastic and Reconstructive Surgery 141, no. 6: 937e–949e. 10.1097/PRS.0000000000004421. - DOI - PubMed
    1. Bui, D. T. , Cordeiro P. G., Hu Q. Y., Disa J. J., Pusic A., and Mehrara B. J.. 2007. “Free Flap Reexploration: Indications, Treatment, and Outcomes in 1193 Free Flaps.” Plastic and Reconstructive Surgery 119, no. 7: 2092–2100. 10.1097/01.prs.0000260598.24376.e1. - DOI - PubMed
    1. Cansancao, A. L. , Conde‐Green A., David J. A., Cansancao B., and Vidigal R. A.. 2018. “Use of Tranexamic Acid to Reduce Blood Loss in Liposuction.” Plastic and Reconstructive Surgery 141, no. 5: 1132–1135. 10.1097/PRS.0000000000004282. - DOI - PubMed