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

Kim, Hyun Seok; Pyon, Jai Kyong; Minn, Kyung Won; Heo, Chan Yeong

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2004;31(6):832-838.
Published online November 1, 2004.

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

Hyun Seok Kim, Jai Kyong Pyon, Kyung Won Minn, Chan Yeong Heo

¹Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea. minnkw@snu.ac.kr
²Department of Plastic and Reconstructive Surgery, Samsung Medical Center, Seoul, Korea.
³Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Gyunggi, Korea.

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.

Keywords: Free flap; Intraoperative heparin bolus