Microsurgical free flap and replantation without antithrombotic agents

Abstract

Microsurgical reconstructions for free flap transfer, digits and limb replantation have been highly successful applications in the past decades. Antithrombotic prophylactic agents, such as low-molecular-weight dextran, aspirin and heparin have been routinely used for the prevention of microvascular thrombosis. Even though these agents are efficacious in microsurgery, some systemic morbidity is still reported. Forty cases of microsurgical reconstruction over the last five years are reported. They include 22 cases of free flap transfer and 18 cases of replantation (19 fingers, 2 toes and one hand). The surgery was performed by the same group of plastic surgeons and no antithrombotic agent was given intraoperatively or during the post operative period. Results show one partial flap loss, two replantation losses due to severe crush injuries of the digits and one toe replantation failure in a two year old. The failure of toe replantation was due to surgical technique and poor post operative immobilization. The result shows that successful microsurgical reconstruction depends on many factors. One of the most important factors is microsurgical technique. Use of antithrombotic agents alone does not appear to play a significant role in the patency of microvascular structures.