PMID- 36212097
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221011
IS  - 2292-5503 (Print)
IS  - 2292-5511 (Electronic)
IS  - 2292-5503 (Linking)
VI  - 30
IP  - 4
DP  - 2022 Nov
TI  - Multidisciplinary Practice Variations of Anti-Thrombotic Strategies for Free 
      Tissue Transfers.
PG  - 343-352
LID - 10.1177/22925503211024742 [doi]
AB  - Background: Venous thrombosis, the leading cause of free flap failure, may have 
      devastating consequences. Many anti-thrombotic agents and protocols have been 
      described for prophylaxis and treatment of venous thrombosis in free flaps. 
      Methods: National surveys were distributed to microsurgeons (of both Plastics and 
      ENT training) and hematology and thrombosis specialists. Data were collected on 
      routine screening practices, perceived risk factors for flap failure, and pre-, 
      intra-, and post-operative anti-thrombotic strategies. Results: There were 722 
      surveys distributed with 132 (18%) respondents, consisting of 102 surgeons and 30 
      hematologists. Sixty-five surgeons and 9 hematologists routinely performed or 
      managed patients with free flaps. The top 3 perceived risk factors for flap 
      failure according to surgeons were medical co-morbidities, past arterial 
      thrombosis, and thrombophilia. Hematologists, however, reported diabetes, 
      smoking, and medical co-morbidities as the most important risk factors. 
      Fifty-four percent of physicians routinely used unfractionated heparin (UFH) or 
      low-molecular-weight heparin (LMWH) as a preoperative agent. Surgeons routinely 
      flushed the flap with heparin (37%), used UFH IV (6%), or both (8%) 
      intra-operatively. Surgeons used a range of post-operative agents such as UFH, 
      LMWH, aspirin, and dextran while hematologists preferred LMWH. There was 
      variation of management strategies if flap thrombosis occurred. Different 
      strategies consisted of changing recipient vessels, UFH IV, flushing the flap, 
      adding post-operative agents, or a combination of strategies. Conclusions: There 
      are diverse practice variations in anti-thrombotic strategies for free tissue 
      transfers and a difference in perceived risk factors for flap failure that may 
      affect patient management.
CI  - (c) 2021 The Author(s).
FAU - Huynh, Minh N Q
AU  - Huynh MNQ
AUID- ORCID: 0000-0003-3931-1351
AD  - Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada.
FAU - Bhagirath, Vinai
AU  - Bhagirath V
AD  - Division of Hematology, McMaster University, Hamilton, Ontario, Canada.
FAU - Gupta, Michael
AU  - Gupta M
AD  - Division of Otolaryngology, McMaster University, Hamilton, Ontario, Canada.
FAU - Avram, Ronen
AU  - Avram R
AD  - Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada.
FAU - Cheung, Kevin
AU  - Cheung K
AD  - Division of Plastic and Reconstructive Surgery, Children's Hospital of Eastern 
      Ontario, Ottawa, Ontario, Canada.
LA  - eng
PT  - Journal Article
DEP - 20210623
PL  - United States
TA  - Plast Surg (Oakv)
JT  - Plastic surgery (Oakville, Ont.)
JID - 101623618
PMC - PMC9537717
OTO - NOTNLM
OT  - anti-thrombotic
OT  - practice variation
OT  - surgical flaps
OT  - thrombosis
COIS- The author(s) declared no potential conflicts of interest with respect to the 
      research, authorship, and/or publication of this article.
EDAT- 2022/10/11 06:00
MHDA- 2022/10/11 06:01
PMCR- 2021/06/23
CRDT- 2022/10/10 04:05
PHST- 2020/01/10 00:00 [received]
PHST- 2021/04/25 00:00 [accepted]
PHST- 2022/10/10 04:05 [entrez]
PHST- 2022/10/11 06:00 [pubmed]
PHST- 2022/10/11 06:01 [medline]
PHST- 2021/06/23 00:00 [pmc-release]
AID - 10.1177_22925503211024742 [pii]
AID - 10.1177/22925503211024742 [doi]
PST - ppublish
SO  - Plast Surg (Oakv). 2022 Nov;30(4):343-352. doi: 10.1177/22925503211024742. Epub 
      2021 Jun 23.