Evaluating the Role of Low Molecular Heparin to Prevent Anterolateral Thigh Flap Compromise in 2460 Head and Neck Defect Cases

Abstract

Since thrombosis is the leading cause of free flap failure, anticoagulant agents appear to improve free flap survival by decreasing the probability of thrombus formation. This retrospective study primarily aimed to evaluate the outcomes and complications of anterolateral thigh flap (ALT) transfer in patients who were postoperatively treated with or without low molecular weight heparin (LMWH) calcium. This was a retrospective study. The sample comprised patients who underwent ALT transfer between January 2015 and January 2020 in the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital. The predictor variable was LMWH. The outcome variable was flap compromise. Other study variables were age, sex, defect location, hypertension, diabetes, number of vein anastomoses, alcohol history, radiation history, and hematoma. Descriptive, bivariate, and regression statistics were computed, and the P value was set at 0.05. The sample was composed of 2460 patients, comprising 2,234 males and 226 females, with a mean age of 50.5years (range, 19-79years). Based on the use of LMWH, the patients were divided into experimental and control groups. There were no significant differences in the clinical characteristics between the groups. Moreover, there were no significant differences in flap compromise or hematoma incidence between the groups. In the logistic regression model for flap compromise, the only factor found to be associated with flap compromise was hematoma (P<.0001). The use of LMWH in head and neck free flap transfer does not reduce the incidence of thrombosis and flap compromise.