INTRODUCTION: Historically, head and neck cancer patients undergoing free flap reconstruction received Dextran for thrombosis prevention. This treatment protocol, while successful, does not address the need for deep vein thombosis (DVT) prophylaxis in these high risk patients and requires frequent dosing. The emergence of Low-Molecular Weight Heparin (LMWH) has given rise to alternatives for DVT prophylaxis and treatment. Therefore, it is plausible that LMWH could have an extended use in the arena of microvascular anastomoses as it provides adequate anticoagulation, DVT prevention, and convenient administration. Additionally, aspirin has been suggested to be of benefit as an antiplatelet therapy. The purpose of this study was to evaluate the regimen of aspirin and LMWH as it compared to Dextran in free tissue surgical reconstruction of head and neck defects.

METHODS: A retrospective chart review was performed on 75 cases in which the patients underwent free tissue transfer for head and neck reconstruction. The study encompassed all cases performed during the period of September 2003 to February 2007. Charts were reviewed to determine the incidence of postoperative complications, specifically thrombotic complications including flap failure, partial loss, pulmonary embolism, and deep venous thromboembolism.

RESULTS: Of the 75 of patients, 39 cases employed the use of Dextran for thrombosis prophylaxis. This regimen resulted in the following complications: seven flap failures (four arterial, three venous), four hematomas, three partial flap losses, two deaths (pulmonary embolism, cerebrovascular accident and subsequent cardiopulmonary arrest), and one deep venous thromboembolism. In comparison, 36 patients given a thrombosis prophylactic regimen consisting of aspirin and LMWH experienced the following complications: three hematomas, two flap failures (venous), two myocardial infarctions resulting in death, one cerebrovascular accident, one flap dehiscence, and one skin paddle epidermolysis.

DISCUSSION: In review of this data, the use of aspirin and LMWH for anticoagulation and antiplatelet therapy provide effective measures in preventing thrombotic events while resulting in fewer post-surgical complications in comparison to Dextran. The clinical implications include the possibility of replacing the current standard of care for patients undergoing head and neck free flap reconstructive surgery.