Abstract
The aim of this study was to verify the advantages and disadvantages of heparin application after microvascular anastomosed flaps in oral and maxillofacial surgery and to get a benefit for clinical practice. Between the beginning of February 2012 and the end of February 2015, 100 microvascular-anastomosed flaps were performed in the Department of Oral and Maxillofacial Surgery at the Klinikum Bremen-Mitte. In 95% of the cases the aPTT was extended by heparin in the sense of an anticoagulation. In 79% of the 100 cases, the flap was successfully retained. An anticoagulant therapy has previously been regarded as an established procedure for the prevention of venous thrombosis of the vascular pedicle in microvascular flaps. Due to the check-ability and controllability of high molecular weight heparin, heparin is currently the most effective choice for postoperative anticoagulant therapy in microvascular flap surgery. An anticoagulant therapy with heparin requires attention and intensive care. The application of heparin increases the risk of complications, e.g. a heparin-induced thrombocytopenia or the risk of bleeding. The extent to which hemostasis-inhibiting / anticoagulative therapy is useful is questionable. A significant difference was not recorded in our own research and in the latest literature. Factors influencing flap survival seem to be multifactorial. The indication for the operation must be well thought-out in order not to jeopardize the success of the operation and the survival of the patients. Patients who are suspected of endothelial tissue defects who, for example, have received a prior combination treatment with radio- and chemotherapy, show a significantly higher risk of the surgery's success in graft survival. Further prospective randomized trials are needed to demonstrate that and to what extent hemostasis-inhibiting therapy has an impact on flap survival.
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