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Microsurgical Free Flap and Replantation without Antithrombotic Agents


Lek Veravuthipakorn MD*,
Apisit Veravuthipakorn MD**
* Department of Surgery, Rajavithi Hospital
** Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University


Microsurgical reconstructions for free flap transfer, digits and limb replantation have been
highly successful applications in the past decades. Antithrombotic prophylactic agents, such as lowmolecular-
weight dextran, aspirin and heparin have been routinely used for the prevention of microvascular
thrombosis. Even though these agents are efficacious in microsurgery, some systemic morbidity is still
reported. Forty cases of microsurgical reconstruction over the last five years are reported. They include 22
cases of free flap transfer and 18 cases of replantation (19 fingers, 2 toes and one hand). The surgery was
performed by the same group of plastic surgeons and no antithrombotic agent was given intraoperatively or
during the post operative period. Results show one partial flap loss, two replantation losses due to severe
crush injuries of the digits and one toe replantation failure in a two year old. The failure of toe replantation
was due to surgical technique and poor post operative immobilization. The result shows that successful
microsurgical reconstruction depends on many factors. One of the most important factors is microsurgical
technique. Use of antithrombotic agents alone does not appear to play a significant role in the patency of
microvascular structures.

Keyword : Antithrombotic agent, Microsurgical free flap, Replantation

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