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Low-molecular-weight heparin salvage in pedicled flap reconstruction in head and neck: a prospective cohort study

Published online by Cambridge University Press:  11 April 2024

Smriti Panda Open the ORCID record for Smriti Panda [Opens in a new window] ,
Vimmi Gautam ,
Sandipta Mitra ,
Chirom Amit Singh ,
Suresh Mani ,
Akshara Palreddy ,
Yuvanesh Kabilan ,
Abhilash Konkimalla ,
Dheeraj Kondamudi  and
Debadeep Bagchi
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Smriti Panda*
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Vimmi Gautam
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Sandipta Mitra
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Chirom Amit Singh
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Suresh Mani
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Akshara Palreddy
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Yuvanesh Kabilan
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Abhilash Konkimalla
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Dheeraj Kondamudi
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Debadeep Bagchi
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Sarath Raveendran
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Kapil Sikka
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Rajeev Kumar
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Anup Singh
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
Alok Thakar
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
*
Corresponding author: Smriti Panda; Email: [email protected]
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Abstract

Objective

To determine if systemic administration of low-molecular-weight heparin impacts venous compromise in loco-regional flap reconstruction for head and neck subsites.

Methods

This prospective study was conducted on patients who had developed features of venous compromise of the flap. The case group received low-molecular-weight heparin (dalteparin).

Results

Of the 73 patients who developed venous congestion, low-molecular-weight heparin was administered in 47 patients. In the low-molecular-weight heparin subset, 23 patients had either reversal or non-progression of venous compromise (48.9 per cent). Of the patients who had no response to low-molecular-weight heparin rescue, complete necrosis was seen in 4 and partial flap necrosis was observed in 19. The corresponding numbers in the control group were 13 and 12, respectively (odds ratio 23.9, p = 0.002). Additionally, the low-molecular-weight heparin arm had a lower incidence of partial or complete flap necrosis (p = 0.002).

Conclusion

Low-molecular-weight heparin salvage, when instituted early, is likely to result in a significant reduction in flap-related morbidity.

Keywords

heparinlow-molecular weightoral cancervenous thrombosisprophylaxis
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 138 , Issue 8 , August 2024 , pp. 852 - 857
Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Smriti Panda takes responsibility for the integrity of the content of the paper

This paper was presented in the ‘Most Outstanding Work’ section of the 2022 International Conference of the Korean Society for Head and Neck Oncology 24–25 September 2022, at Seoul, South Korea

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