Download PDF
J Reconstr Microsurg
DOI: 10.1055/a-2460-4761
Original Article

Antithrombotic Agents after Free Tissue Transfer in the Pediatric and Adolescent Population

Jakob B.W. Weiss 
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg; Freiburg, Germany
,
Branislav Kollár 
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg; Freiburg, Germany
,
Steffen U. Eisenhardt
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg; Freiburg, Germany
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Even for the experienced microsurgeon, free tissue transfer in pediatric patients is challenging, and large patient series remain scarce in the literature. Moreover, the added value of antithrombotic agents in pediatric free tissue transfer remains unclear.

Methods We conducted a retrospective outcome analysis of pediatric free tissue transfer with respect to postoperative antithrombotic treatment at our tertiary academic center. All patients aged 0 to 18 years who underwent free tissue transfer from 1998 to 2022 were included in the study.

Results Seventy patients received 73 free tissue transfers. The most common indications were facial paralysis, trauma, and tumor (49.3, 21.9, and 20.5%, respectively). The most common recipient sites were the head and neck (56.1%) and lower extremity (32.8%). We observed a flap revision rate of 12.5% of the cases and one flap loss (1.4%). A total of 58.9% of the population received postoperative antithrombotic agents. The rate of flap revision surgery was similar (11.6 and 10.0%, respectively), with and without antithrombotic treatment (p > 0.05). There were no major bleeding complications or deep vein thrombosis.

Conclusion The antithrombotic treatment did not seem to affect the flap revision rate or the bleeding complications in our cohort. Hence, the data do not support the routine administration of antithrombotic treatment in pediatric free flap reconstruction. However, these findings should be solidified in prospective randomized trials.

Keywords

microsurgery - pediatric reconstructive surgery - antithrombotics

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.


Patient Consent Statement

Informed consent for the publication of photographs was obtained from the patients shown in this study.




Publication History

Received: 11 July 2024

Accepted: 16 October 2024

Accepted Manuscript online:
04 November 2024

Article published online:
29 November 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Harii K, Ohmori K. Free groin flaps in children. Plast Reconstr Surg 1975; 55 (05) 588-592
    CrossrefPubMedSearch in Google Scholar
  • 2 Ohmori K, Harii K, Sekiguchi J, Torii S. The youngest free groin flap yet?. Br J Plast Surg 1977; 30 (04) 273-276
    CrossrefPubMedSearch in Google Scholar
  • 3 Gilbert A. Reconstruction of congenital hand defects with microvascular toe transfers. Hand Clin 1985; 1 (02) 351-360
    CrossrefPubMedSearch in Google Scholar
  • 4 Upton J, Guo L, Labow BI. Pediatric free-tissue transfer. Plast Reconstr Surg 2009; 124 (6, Suppl): e313-e326
    CrossrefPubMedSearch in Google Scholar
  • 5 Upton J, Guo L. Pediatric free tissue transfer: a 29-year experience with 433 transfers. Plast Reconstr Surg 2008; 121 (05) 1725-1737
    CrossrefPubMedSearch in Google Scholar
  • 6 Chung TL, Pumplin DW, Holton III LH, Taylor JA, Rodriguez ED, Silverman RP. Prevention of microsurgical anastomotic thrombosis using aspirin, heparin, and the glycoprotein IIb/IIIa inhibitor tirofiban. Plast Reconstr Surg 2007; 120 (05) 1281-1288
    CrossrefPubMedSearch in Google Scholar
  • 7 Lee KT, Mun GH. The efficacy of postoperative antithrombotics in free flap surgery: a systematic review and meta-analysis. Plast Reconstr Surg 2015; 135 (04) 1124-1139
    CrossrefPubMedSearch in Google Scholar
  • 8 Burns HR, Skochdopole AJ, Alfaro Zeledon R, Pederson WC. Pediatric microsurgery and free-tissue transfer. Semin Plast Surg 2023; 37 (04) 231-239
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Leibig N, Ha-Phuoc A, Stark GB. et al. Retrospective evaluation of diagnostic accuracy of free flap monitoring with the Cook-Swartz-Doppler probe in head and neck reconstruction. J Craniomaxillofac Surg 2019; 47 (12) 1973-1979
    CrossrefPubMedSearch in Google Scholar
  • 10 S3-Leitlinie Prophylaxe der venösen Thromboembolie (VTE), 2. komplett überarbeitete Auflage.
    PubMed
  • 11 Jacobi FJ, Jacobi SF, Kari FA, Eisenhardt SU. Autologous free tissue transfer in paediatric patient with a univentricular heart. Interact Cardiovasc Thorac Surg 2022; 35 (02) ivac177
    CrossrefPubMedSearch in Google Scholar
  • 12 Devaraj VS, Kay SP, Batchelor AG, Yates A. Microvascular surgery in children. Br J Plast Surg 1991; 44 (04) 276-280
    CrossrefPubMedSearch in Google Scholar
  • 13 Aboelatta YA, Aly HM. Free tissue transfer and replantation in pediatric patients: technical feasibility and outcome in a series of 28 patients. J Hand Microsurg 2013; 5 (02) 74-80
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Srikanth R. Free tissue transfer in pediatric lower limb trauma. Indian J Plast Surg 2019; 52 (01) 37-44
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Canales F, Lineaweaver WC, Furnas H. et al. Microvascular tissue transfer in paediatric patients: analysis of 106 cases. Br J Plast Surg 1991; 44 (06) 423-427
    CrossrefPubMedSearch in Google Scholar
  • 16 Clarke HM, Upton J, Zuker RM, Manktelow RT. Pediatric free tissue transfer: an evaluation of 99 cases. Can J Surg 1993; 36 (06) 525-528
    PubMedSearch in Google Scholar
  • 17 Pinder RM, Hart A, Winterton RIS, Yates A, Kay SPJ. Free tissue transfers in the first 2 years of life–a successful cost effective and humane option. J Plast Reconstr Aesthet Surg 2010; 63 (04) 616-622
    CrossrefPubMedSearch in Google Scholar
  • 18 Lin CH, Mardini S, Wei FC, Lin YT, Chen CT. Free flap reconstruction of foot and ankle defects in pediatric patients: long-term outcome in 91 cases. Plast Reconstr Surg 2006; 117 (07) 2478-2487
    CrossrefPubMedSearch in Google Scholar
  • 19 Stephan B, Schenk JF, Nemeh A, Pindur G. The use of antithrombotic agents in microvascular surgery. Clin Hemorheol Microcirc 2009; 43 (1–2): 51-56
    CrossrefPubMedSearch in Google Scholar
  • 20 Lighthall JG, Cain R, Ghanem TA, Wax MK. Effect of postoperative aspirin on outcomes in microvascular free tissue transfer surgery. Otolaryngol Head Neck Surg 2013; 148 (01) 40-46
    CrossrefPubMedSearch in Google Scholar
  • 21 Conrad MH, Adams Jr WP. Pharmacologic optimization of microsurgery in the new millennium. Plast Reconstr Surg 2001; 108 (07) 2088-2096 , quiz 2097
    CrossrefPubMedSearch in Google Scholar
  • 22 Organek AJ, Klebuc MJ, Zuker RM. Indications and outcomes of free tissue transfer to the lower extremity in children: review. J Reconstr Microsurg 2006; 22 (03) 173-181
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Parry SW, Toth BA, Elliott LF. Microvascular free-tissue transfer in children. Plast Reconstr Surg 1988; 81 (06) 838-840
    CrossrefPubMedSearch in Google Scholar
  • 24 Shapiro J, Akbarnia BA, Hanel DP. Free tissue transfer in children. J Pediatr Orthop 1989; 9 (05) 590-595
    CrossrefPubMedSearch in Google Scholar
  • 25 Alkureishi LWT, Purnell CA, Park P, Bauer BS, Fine NA, Sisco M. Long-term outcomes after pediatric free flap reconstruction. Ann Plast Surg 2018; 81 (04) 449-455
    CrossrefPubMedSearch in Google Scholar
  • 26 Rashid HU, Rashid M, Rehman IU. et al. Comparison of microvascular free tissue transfer in adult and paediatric patients. J Ayub Med Coll Abbottabad 2019; 31 (02) 156-161
    PubMedSearch in Google Scholar
  • 27 Elledge R, Parmar S. Free flaps for head and neck cancer in paediatric and neonatal patients. Curr Opin Otolaryngol Head Neck Surg 2018; 26 (02) 127-133
    CrossrefPubMedSearch in Google Scholar
  • 28 Claes KE, Roche NA, Opsomer D, De Wolf EJ, Sommeling CE, Van Landuyt K. Free flaps for lower limb soft tissue reconstruction in children: systematic review. J Plast Reconstr Aesthet Surg 2019; 72 (05) 711-728
    CrossrefPubMedSearch in Google Scholar
  • 29 Houdek MT, Rose PS, Milbrandt TA, Stans AA, Moran SL, Sim FH. Comparison of pediatric intercalary allograft reconstructions with and without a free vascularized fibula. Plast Reconstr Surg 2018; 142 (04) 1065-1071
    CrossrefPubMedSearch in Google Scholar
  • 30 Weber RA, Pederson WC. Skin paddle salvage in the fibula osteocutaneous free flap with secondary skin paddle vascular anastomosis. J Reconstr Microsurg 1995; 11 (04) 239-241 , discussion 242–244
    Thieme ConnectPubMedSearch in Google Scholar