Low-molecular-weight heparin salvage in pedicled flap reconstruction in head and neck: a prospective cohort study

J Laryngol Otol. 2024 Aug;138(8):852-857. doi: 10.1017/S0022215124000562. Epub 2024 Apr 11.

Abstract

Objective: To determine if systemic administration of low-molecular-weight heparin impacts venous compromise in loco-regional flap reconstruction for head and neck subsites.

Methods: This prospective study was conducted on patients who had developed features of venous compromise of the flap. The case group received low-molecular-weight heparin (dalteparin).

Results: Of the 73 patients who developed venous congestion, low-molecular-weight heparin was administered in 47 patients. In the low-molecular-weight heparin subset, 23 patients had either reversal or non-progression of venous compromise (48.9 per cent). Of the patients who had no response to low-molecular-weight heparin rescue, complete necrosis was seen in 4 and partial flap necrosis was observed in 19. The corresponding numbers in the control group were 13 and 12, respectively (odds ratio 23.9, p = 0.002). Additionally, the low-molecular-weight heparin arm had a lower incidence of partial or complete flap necrosis (p = 0.002).

Conclusion: Low-molecular-weight heparin salvage, when instituted early, is likely to result in a significant reduction in flap-related morbidity.

Keywords: heparin; low-molecular weight; oral cancer; prophylaxis; venous thrombosis.

MeSH terms

  • Adult
  • Aged
  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use
  • Dalteparin / administration & dosage
  • Dalteparin / therapeutic use
  • Female
  • Head and Neck Neoplasms* / surgery
  • Heparin, Low-Molecular-Weight* / adverse effects
  • Heparin, Low-Molecular-Weight* / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Necrosis / etiology
  • Plastic Surgery Procedures* / methods
  • Prospective Studies
  • Salvage Therapy / methods
  • Surgical Flaps*

Substances

  • Heparin, Low-Molecular-Weight
  • Dalteparin
  • Anticoagulants