Efficacy and Morbidity of Heparin Infusion in Salvaging Autologous Breast Reconstruction Free Flaps.
Research article published in Microsurgery (2025)
Abstract
BACKGROUND: Abdominal-based free flaps are the mainstay in autologous breast reconstruction. Their safety and consistency in outcomes are well-documented. When flap compromise occurs, operative salvage is the gold standard. However, when-and if-to place these patients on heparin infusions is unclear. The goal of this study was to investigate abdominal-based free flap compromise and compare outcomes with and without heparin infusion. MATERIALS AND METHODS: This was a single-institution, multiple-surgeon, retrospective chart review of patients undergoing autologous, abdominal-based free flap breast reconstruction who experienced anastomotic compromise within a 6-year period. Treatment and outcomes data collected include flap salvage, hematoma, seroma, surgical site infection (SSI), transfusion requirement, and length of hospital stay. RESULTS: Fifty-one flaps had evidence of compromise. A total of 31 (60.8%) patients were placed on heparin infusions after experiencing anastomotic compromise, compared to 20 who did not receive heparin infusion. Thirty-five patients (68.6%) underwent deep inferior epigastric perforator flaps. Twenty-six patients (51%) experienced venous congestion, 22 patients (43.1%) experienced arterial compromise, and three (5.9%) experienced both. Twenty-eight patients (54.9%) received tissue plasminogen activator; in the heparin infusion group, 21 patients (67.7%) received tissue plasminogen activator. The total salvage rate of compromised flaps was 94.1% (48/51). There was no significant difference between heparin infusion and standard cares in length of hospital stay, length of drains in-place, successful salvage (93.5% vs. 95%), hematoma (19.4% vs. 15%), fat necrosis, SSI, hospital readmission (19.4% vs. 15%), and return rates to the operating room (48.4% vs. 50%). However, there was a significantly higher transfusion rate in patients receiving heparin infusion (38.7% vs. 10%). Of the 25 flaps with evidence of thrombosis, 72% were placed on heparin infusions while 28% were not; there was no significant difference in salvage rate in this sub-group. CONCLUSIONS: This review of autologous breast reconstruction free flap compromise provides evidence of similar safety profiles, with similar salvage rates, when comparing salvage with and without heparin infusion; there is a higher transfusion requirement when treating with heparin infusion.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Abdominal-based free flaps are the mainstay in autologous breast reconstruction. Their safety and consistency in outcomes are well-documented.
Warum dies für die Hirudotherapie relevant ist
This single-institution retrospective chart review compared outcomes in 51 compromised autologous abdominal-based free flap breast reconstructions with and without heparin infusion, finding no significant difference in salvage rates (93.5% vs. 95%) but a significantly higher transfusion rate with heparin (38.7% vs. 10%, p not specified). The study has indirect contextual relevance to ASH's domain because reconstructive free flap surgery is a setting where leech therapy is sometimes employed for venous congestion salvage, though this abstract makes no mention of leeches or hirudin. Caveat: This study examines systemic heparin infusion only and does not involve leech therapy, bivalirudin, or any leech-derived compound; any connection to ASH's domain is limited to the shared clinical context of microsurgical flap salvage.
Zitation
Efficacy and Morbidity of Heparin Infusion in Salvaging Autologous Breast Reconstruction Free Flaps.
Odorico et al. · Microsurgery, 2025
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