ArticleMicrosurgery2025
Use of Tranexamic Acid in Head and Neck Free Flap Reconstruction.
Article in Microsurgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- The efficacy of local tranexamic acid injection in reducing intraoperative bleeding and improving surgical field quality in septoplasty: a randomized controlled trial.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2026Article
- Perioperative tranexamic acid in abdominally based free-flap breast reconstruction: A single-surgeon retrospective series.JPRAS open · 2026Article
- Mythbusters in Microsurgery: Evaluating Evidence and Debunking Dogma-A Practical Review: Part II.Plastic and reconstructive surgery. Global open · 2026Review
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionTranexamic acid (TXA) is commonly used in surgical settings to reduce blood loss. Due to its antifibrinolytic properties, TXA theoretically increases the risk of thrombosis. In this study, the use of TXA was assessed in patients undergoing head and neck free flap reconstruction.
methodsA cohort of patients from February 2021 to September 2023 received TXA. Patients received 3 g of intravenous TXA intraoperatively, in addition to topical TXA to the donor, recipient, and neck dissection sites. Patients were compared to a retrospective cohort from August 2019 to January 2021. All patients, including those in the retrospective control cohort, met the criteria for TXA.
resultsA total of 397 patients underwent free flap reconstruction (53.6% thigh, 25.6% fibula), of which 185 received TXA and 212 did not. Patients receiving the TXA protocol had a lower perioperative transfusion rate (12.9% vs. 20.7%, p = 0.042) and intraoperative estimated blood loss (196.4 ± 102.9 cc vs. 263.7 ± 247.8 cc, p < 0.001). There was no difference in postoperative flap vascular compromise in the TXA (7.6%) versus control (10.4%) groups (p = 0.33). Postoperative complications, including hematoma and thromboembolic events, were not statistically different between the groups. On multivariate analysis, the use of TXA remained predictive of reduced perioperative transfusion when controlling for BMI > 25, osseous flap, and hypertension.
conclusionPatients who received TXA demonstrated decreased perioperative transfusion after head and neck free flap reconstruction with no increase in flap vascular compromise or major thromboembolic events. Implementation of our protocol to larger cohorts and randomized controlled trials could help identify an optimal dosing regimen and demonstrate long-term efficacy.
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