WORLD JOURNAL OF PLASTIC SURGERY
مجله جهانی جراحی پلاستیک
WJPS
Medical Sciences
http://wjps.ir
1
admin
2228-7914
2252-0724
8
10.61186/wjps
14
8888
13
en
jalali
1398
6
1
gregorian
2019
9
1
8
3
online
1
fulltext
en
Selective and Continuous Transarterial Heparin Infusion: Postmicrosurgical Therapy of Lower Leg Reconstruction for Cases with Recipient Artery Damage
تخصصي
Special
مقالات اصيل
Original Article
<div><span style="font-size: 13px;">BACKGROUND</span></div>
<div><span style="font-size: 13px;">Microsurgical lower extremity reconstruction is challenging because of high incidence of vascular thrombosis compared to microsurgical head and neck reconstruction. The risk of vascular pedicle thrombosis increases, if patients have arterial sclerosis or intimal dissection at the recipient artery. We performed selective and continuous transarterial heparin infusion for postoperative anticoagulant therapy. </span></div>
<div><span style="font-size: 13px;">METHODS</span></div>
<div><span style="font-size: 13px;">Fifteen patients (10 men and 5 women; mean age of 55.1 years; range of 16–86 years) received lower leg reconstruction using free flap. Postoperatively, a catheter was inserted into the femoral artery during surgery. Heparin infusion was performed through the catheter as a postoperative therapy for patients who had a risk factor of vascular pedicle thrombosis. Until two days post-operation, heparin was started between 5,000 and 10,000 IU per day. In postoperative days 3 and 4, half of the initial dose of heparin was administered. In postoperative days 5 and 6, 25% of the initial dose of heparin was administered. </span></div>
<div><span style="font-size: 13px;">RESULTS</span></div>
<div><span style="font-size: 13px;">Recipient arteries were the posterior tibial (n=11), anterior tibial (n=2), lateral circumflex femoral (n=1), and medial sural (n=1) arteries. Thirteen of the 15 cases showed arterial sclerosis or intimal dissection at the recipient artery. There was no case of vascular thrombosis. Hematoma formation at flap recipient was observed in four cases. Their initial heparin dose was than 8.5±1.7 U/kg/h. </span></div>
<div><span style="font-size: 13px;">CONCLUSION</span></div>
<div><span style="font-size: 13px;">Continuous transarterial heparin infusion was an effective anticoagulant therapy for the patients who had received free tissue transfer to a lower extremity. The initial dose of heparin should not exceed 6.5 U/kg/h. </span></div>
Microsurgery, Postoperative therapy, Anticoagulant therapy, Free flap
298
304
http://wjps.ir/browse.php?a_code=A-10-485-1&slc_lang=en&sid=1
Masayuki
Okochi
oktms-okt@umin.ac.jp
10031947532846007286
10031947532846007286
Yes
Teikyo University
Yuzo
Komuro
YKomuro@yahoo.co.jp
10031947532846007287
10031947532846007287
No
Department of Plastic and Reconstructive Surgery, Teikyo University, Tokyo, Japan
Kazuki
Ueda
uedakazu@fmu.ac.jp
10031947532846007288
10031947532846007288
No
Department of Plastic and Reconstructive Surgery, Jusendo General Hospital, Tokyo, Japan