Evidence map›Paper›PMID 40012031›Full record

ArticleBMC anesthesiology2025

Impact of perioperative anticoagulation management on free flap survival in reconstructive surgery: a retrospective analysis.

Saeed Torabi, Remco Overbeek, Fabian Dusse, Sandra E Stoll, Carolin Schroeder, Max Zinser, Matthias Zirk

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC anesthesiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Review
  3. [Research progress on perioperative anticoagulants in perioperative period of free flap transplantation].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2025
    Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Saeed TorabiDepartment of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany. saeed.torabi@uk-koeln.de.
Remco OverbeekDepartment of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
Fabian DusseDepartment of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
Sandra E StollDepartment of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
Carolin SchroederDepartment for Oral and Craniomaxillofacial and Plastic Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
Max ZinserDepartment of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
Matthias ZirkDepartment for Oral and Craniomaxillofacial and Plastic Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDespite advancements in surgical techniques and perioperative care for free flap reconstructive surgery, concerns persist regarding the risk of free flap failure, with thrombosis and bleeding being the most common complications that can lead to flap loss. While perioperative anticoagulation management is crucial for optimizing outcomes in free flap reconstructive surgery, standardized protocols remain lacking. This study aims to investigate the role of anticoagulation and perioperative practices in free flap reconstructive surgery and their impact on surgical outcomes.

methodsThis retrospective, single-center study included all adult patients undergoing free flap surgery from 2009 to 2020. Patients were retrospectively divided based on intraoperative (UFH or no UFH) and postoperative anticoagulation management (UFH only, Aspirin and UFH, Aspirin only). The relationship between anticoagulation protocols, PTT values, and flap survival was assessed.

resultsA total of 489 free flap surgeries were included. Most flaps were taken from the upper extremity (49.5%), primarily for tumor-related reconstructions (85.7%). Flap loss occurred in 14.5% of cases, with a median time to flap loss of 3 days post-surgery. Intraoperative UFH (20 IU/kg) was administered to 63.6% of patients and significantly predicted flap survival (OR = 0.45, 95% CI [0.24, 0.82]). PTT values on day 1 post-surgery were significantly related to flap survival (P = 0.03), with each unit increase reducing the relative probability of flap loss by 5.2%. There was no significant difference in flap survival between patients treated with heparin alone and those treated with both heparin and aspirin. The small sample size in the aspirin-only group limited the statistical relevance of this subgroup.

conclusionOur findings highlight the importance of intraoperative UFH and PTT-guided postoperative management in improving free flap survival. Standardized anticoagulation protocols are essential for enhancing outcomes in free flap reconstructive surgery.

Indexed as

AnticoagulantsFree Tissue FlapsGraft SurvivalPerioperative CarePlastic Surgery ProceduresAdultAgedAspirinFemaleHumansMaleMiddle AgedRetrospective StudiesAnticoagulantsAspirinFree flap surgery outcomeIntraoperative heparin AdministrationMicrovascular Surgery ComplicationsPerioperative Anticoagulation managementPostoperative PTT-Guided Anticoagulation

Identifiers

PMID40012031
PMCPMC11863428

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.