Purpose: Reconstruction of the lower extremity using free tissue transfer is performed throughout the country by numerous surgical teams. However, no established protocol exists for perioperative anticoagulation. This study analyzed trends in current anticoagulation protocols regarding lower extremity free flap reconstruction.

Methods: A survey of perioperative anticoagulation protocols for lower extremity free flap reconstruction was designed and distributed via email to members of the American Society of Plastic Surgeons (ASPS).

Results: Of the 3,310 ASPS members contacted via email, 305 (9%) responded that they performed lower extremity free tissue reconstruction and responded to the questionnaire pertaining to perioperative anticoagulation in lower extremity free tissue transfer.

10.2% used preoperative anticoagulation, 62.2% intraoperative anticoagulation, and 67.3% used postoperative anticoagulation. Preoperatively and postoperatively the anticoagulation of choice was aspirin with aspirin accounting for 60% of preoperative anticoagulation and 67.7% of postoperative anticoagulation. Intraoperatively, the anticoagulation of choice was heparin, accounting for 63.1%.

Conclusion: While no set anticoagulation regimen has been established, there are trends that can be seen regarding the pharmacotherapy that surgeons prefer to use at various intervals in the perioperative period. These trends may in turn be used as a guideline to anticoagulative therapy in lower extremity free tissue reconstruction.