Role of Postoperative Aspirin in Free Tissue Transfer

Abstract

Objective: Examine if flap outcomes and complication rates in free tissue transfer surgery performed by a single microvascular surgeon vary when postoperative aspirin is used as pharmacologic thromboprophylaxis compared with no anticoagulation.

Method: A retrospective chart review was performed using a prospectively maintained microvascular reconstructive database to identify cases of free tissue transfer between February 2006 and April 2010. Outcome variables included complications, flap failure, re-exploration, and salvage. Chi square analysis was performed to identify differences based on type of postoperative antithrombotic therapy.

Results: A total of 390 consecutive free tissue transfer procedures were performed; 184 received no postoperative thromboprophylaxis, 142 received only aspirin, and 54 received a combination of agents. The overall complication rate was 38% with significantly more complications in the aspirin group compared with no prophylaxis (P = .002). There was no significant difference in bleeding complications (P = .192) or flap failure (P = .839) between aspirin and no anticoagulation. There were more postoperative revisions in the aspirin group (P = .039) with a trend toward a higher salvage rate in these cases (P = .058) when compared with the no prophylaxis group.

Conclusion: Postoperative thromboprophylaxis with aspirin after microvascular free tissue transfer is associated with a higher complication rate without an increase in bleeding or improvement in free flap survival in our series. Prospective, randomized studies are required to elucidate the role of postoperative pharmacotherapy for prophylaxis against microvascular thrombosis.