J Korean Soc Plast Reconstr Surg.  2004 Nov;31(6):832-838.

Clinical Experience of a Single Intraoperative Bolus of Heparin as a Systemic Antithrombotic Therapy in Free Flap Surgery

• Kim HS
• Pyon JK
• Minn KW
• Heo CY

Abstract

Although antithrombotic drug therapy is not a substitute for precise surgical technique, it has become an important adjunct for the microsurgeon performing replantation and elective free-tissue transfers. Systemic anticoagulant use in 60 free flap procedures performed from January 2001 to February 2004 was reviewed to determine the flap loss rate, associated risk of hematoma formation and heparin-induced thrombocytopenia. Patients were divided into two groups: a single intraoperative bolus of 1250 units of heparin(20 flaps, Group 1), 2500 units(40 flaps, Group 2) respectively. Partial and complete flap loss rate was higher in Group 1(35 percent) than in Group 2(10 percent). Neither the difference in hematoma incidence nor the difference in thrombocytopenia incidence between two groups was significant and there was no case presenting heparin- induced thrombocytopenia. We have encountered unusually high flap loss rate in the group who received a single intraoperative bolus of 1250 units of heparin. Although a cause-and-effect relationship between the use of systemic heparin and flap loss or prevention of thrombosis could not be established, it seems to be beneficial that a single bolus of 2500 units of heparin is given intraoperatively without significantly increasing the risk of hematoma or heparin-induced thrombocytopenia.

Keyword

Free flap; Intraoperative heparin bolus

MeSH Terms

Drug Therapy
Free Tissue Flaps*
Hematoma
Heparin*
Humans
Incidence
Replantation
Thrombocytopenia
Thrombosis
Heparin