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.
Resumen
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Por qué esto importa para la hirudoterapia
Esta serie de casos retrospectiva de un solo centro de 15 pacientes de reconstrucción con colgajo libre de cabeza y cuello con coagulopatías hereditarias confirmadas (con mayor frecuencia talasemia falciforme y Factor V de Leiden) encontró que todos recibieron anticoagulación preoperatoria, que 2 de 15 (13,3%) sufrieron pérdida del colgajo por trombosis (ninguno de los dos había recibido anticoagulación intraoperatoria) y que no ocurrió sangrado mayor, lo que llevó a los autores a solicitar anticoagulación individualizada y coordinación multidisciplinaria. Esto es directamente relevante para el mundo clínico en el que se utilizan las sanguijuelas medicinales, porque la supervivencia del colgajo libre depende del drenaje venoso y la trombosis es el modo dominante de fallo del colgajo, el mismo problema para el que se despliega la terapia con sanguijuelas como medida de salvamento para la congestión venosa. Como una pequeña serie retrospectiva de 15 pacientes sin brazo de terapia con sanguijuelas, documenta el escenario trombótico de alto riesgo en lugar de probar la hirudoterapia, y sus hallazgos sobre la estrategia de anticoagulación son solo generadores de hipótesis.
Citación
Head and Neck Free-Flap Reconstruction in Patients With Pre-Existing Coagulopathies: A Case Series.
Longfellow et al. · Ear, nose, & throat journal, 2025
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026