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Scientific Oral Presentations

Facial Plastic and Reconstructive Surgery

Session: Scientific Oral Presentations 3 - Facial Plastic and Reconstructive Surgery

Impact of Lovenox Prophylaxis on Microvascular Free Flap Outcomes

Tuesday, October 1, 2024
11:18 AM – 11:24 AM EDT
Location: MBCC, 222
Disclosure(s):
Kavita Bhatnagar, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Hannah R. Smith, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Farshid Taghizadeh, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Skylar H. Trott, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Daniel R. Clayburgh, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Sara Yang, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Mark K. Wax, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Microvascular free flap reconstruction for head and neck defects carries a 95% success rate, and when flap compromise does occur, it is often due to vascular occlusion of the anastomosis. This study seeks to determine if the addition of Lovenox prophylaxis affects postoperative complications and what impact it may have on flap survival.

Methods: Retrospective review of 1,100 patients at a single institution who received microvascular free flap reconstruction from 01/2010-05/2019. Use of Lovenox prophylaxis began in 2013, and by 2015 was routinely used. Flap status and postoperative complications were compared between those who received no chemoprophylaxis and those who received postoperative Lovenox prophylaxis using a chi-squared analysis. Outcomes among patients on therapeutic heparin and other oral anticoagulants were similarly examined.

Results: There was no difference between those with (n = 716) or without (n = 384) chemoprophylaxis in rates of flap survival (88.54% vs 87.29%), salvage (4.95% vs 6.70%), and failure (6.51% vs. 6.01%), p=0.45. Rates of arterial insufficiency (8.07% vs. 7.82%, p = 0.89) and venous congestion (3.39% vs. 5.73%, p = 0.09) were equivalent. 218 patients received therapeutic heparin and 110 were on other anticoagulation. Arterial insufficiency (23.85%, p < 0.01) and partial flap necrosis (9.17%, p < 0.01) were highest among the therapeutic heparin group. Rate of hematoma was significantly different between those without chemoprophylaxis, those on Lovenox prophylaxis, heparin, and other oral anticoagulants (2.08% vs 3.77% vs 10.55% vs 14.55%, p < 0.01).

Conclusions: Lovenox prophylaxis does not appear to affect overall flap survival but does confer a small increase in hematoma risk. There were higher rates of complications among patients on therapeutic heparin. Patients who require anticoagulation for other medical comorbidities are nearly four times as likely to develop hematomas and should be counseled accordingly.

    Presenting Author(s)

  • KB

    Kavita Bhatnagar, MD

    Resident Physician
    Oregon Health & Science University
    Portland, OR, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Hannah R. Smith, BS

    Medical Student
    Oregon Health & Science University
    Portland, OR, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Farshid Taghizadeh, MD

    Resident physician
    Oregon Health Science University
    Portland, OR, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • GY

    Gavin Young, MS

    Oregon Health Science University School of Medicine, USA

    Disclosure information not submitted.

  • ST

    Skylar H. Trott, MD

    Fellow
    OHSU
    Lexington, KY, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Daniel R. Clayburgh, MD, PhD

    Assistant Professor of Otolaryngology Head and Neck Surgery
    Oregon Health and Science University
    Portland, OR, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Sara Yang, MD

    Assistant Professor
    OHSU
    Portland , OR, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Mark K. Wax, MD

    Professor Otolaryngology/Maxillofacial Surgery, Program Director
    OHSU
    Portland, OR, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.