Abstract
Background Patients undergoing head and neck (H&N) microvascular reconstruction comprise a population
at high risk for venous thromboembolism (VTE). Free flap and VTE thromboprophylaxis
may coincide but tend to vary from surgeon to surgeon. This study identifies VTE prophylaxis
patterns and perceptions among H&N microsurgeons in the United States.
Methods An online survey on VTE prophylaxis practice patterns and perceptions was emailed
to 172 H&N microsurgeons in the United States using an anonymous link.
Results There were 74 respondents (43% response rate). These surgeons completed residencies
in otolaryngology (59%), plastic surgery (31%), and oral maxillofacial surgery (7%).
Most underwent fellowship training (95%) and have practiced at an academic center
(97%) for at least 6 years (58%), performing an average of 42 ± 31 H&N free flap cases
per year (range = 1–190). Most adhered to general VTE prophylaxis guidelines (69%)
while 11% did not and 20% were unsure. Nearly all surgeons (99%) would provide prophylactic
anticoagulation, mostly in the form of subcutaneous heparin (51%) or enoxaparin (44%);
64% additionally used aspirin, while 4% used aspirin alone. The majority of surgeons
(68%) reported having postoperative VTE complications, with six surgeons (8%) reporting
patient deaths due to pulmonary embolism. A third of the surgeons have encountered
VTE prophylaxis-related adverse bleeding events, but most still believe that chemoprophylaxis
is important for VTE prevention (92%). While 35% of surgeons were satisfied with their
current practice, most would find it helpful to have official prophylactic anticoagulation
guidelines specific to H&N free flap cases.
Conclusion The majority of microsurgeons experienced postoperative VTE complications after H&N
free flap reconstruction despite the routine use of prophylactic anticoagulation.
Though bleeding events are a concern, most surgeons believe chemoprophylaxis is important
for VTE prevention and would welcome official guidelines specific to this high-risk
population.
Keywords
survey - free flap - venous thromboembolism
