Head and Neck Free-Flap Reconstruction in Patients With Pre-Existing Coagulopathies: A Case Series
Research article published in Ear, nose, & throat journal (2025)
Abstract
Patients with inherited coagulopathies-including thrombophilias-undergoing microvascular reconstruction face elevated thrombotic risk, yet optimal perioperative strategies remain undefined. This retrospective case series evaluates perioperative outcomes in patients with confirmed inherited coagulopathies who underwent head and neck free flap reconstruction at a single tertiary academic center between April 2014 and October 2024. Fifteen patients met the inclusion criteria (53.3% female; median age 59 years). The most common coagulopathies were sickle cell trait (40.0%) and Factor V Leiden (26.7%). All patients received preoperative anticoagulation: 60.0% received subcutaneous (SC) unfractionated heparin (UFH), 33.3% enoxaparin, and 6.7% fondaparinux. Intraoperative anticoagulation was used in 20.0% of cases, primarily enoxaparin. Postoperative anticoagulation included SC UFH or low-molecular-weight heparin in 86.7% of patients, with 33.3% also receiving aspirin and 20.0% transitioning to direct oral anticoagulants. Two patients (13.3%) experienced flap loss due to thrombosis; neither received intraoperative anticoagulation. No major bleeding events occurred. Transfusions were required in 40.0% postoperatively and 20.0% intraoperatively. These findings underscore the need for targeted screening, multidisciplinary coordination, and individualized anticoagulation regimens to mitigate thrombotic complications in this high-risk population. Further prospective studies are warranted to develop standardized perioperative protocols and optimize microsurgical outcomes in patients with inherited coagulopathies, including hypercoagulable states.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This single-center retrospective case series of 15 head and neck free-flap reconstruction patients with confirmed inherited coagulopathies (most commonly sickle cell trait and Factor V Leiden) found that all received preoperative anticoagulation, that 2 of 15 (13.3%) suffered flap loss from thrombosis (neither having received intraoperative anticoagulation), and that no major bleeding occurred, leading the authors to call for individualized anticoagulation and multidisciplinary coordination. This is directly relevant to the clinical world in which medicinal leeches are used, because free-flap survival hinges on venous outflow and thrombosis is the dominant mode of flap failure, the same problem leech therapy is deployed to relieve as a salvage measure for venous congestion. As a small retrospective series of 15 patients with no leech-therapy arm, it documents the high-risk thrombotic setting rather than testing hirudotherapy, and its findings about anticoagulation strategy are hypothesis-generating only.
Citation
Head and Neck Free-Flap Reconstruction in Patients With Pre-Existing Coagulopathies: A Case Series.
Longfellow et al. · Ear, nose, & throat journal, 2025
Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026