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J Reconstr Microsurg 2013; 29(07): 443-448
DOI: 10.1055/s-0033-1343950
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Safety and Efficacy of Low Molecular Weight Dextran (Dextran 40) in Head and Neck Free Flap Reconstruction

Kiran Jayaprasad
1   Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Jimmy Mathew
1   Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Krishnakumar Thankappan
1   Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Mohit Sharma
1   Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Sriprakash Duraisamy
1   Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Sunil Rajan
2   Department of Anesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Jerry Paul
2   Department of Anesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Subramania Iyer
1   Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
› Author Affiliations
Further Information

Publication History

27 September 2012

30 December 2012

Publication Date:
22 April 2013 (online)

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Abstract

Background Antithrombotic agents have been used in microvascular surgeries. Low molecular weight dextran (dextran 40), though used, is not without complications.

Methods Retrospective analysis of 172 consecutive flaps. A comparison was made between two groups of patients (86 flaps each) with and without the use of dextran 40, in terms of safety and efficacy.

Results The free flap survival rate was 95.9%. The flap survival rates were comparable between the groups. Total flap loss in Group A (patients who received dextran 40) was 3.5% compared with 2.3% in Group B (patients who did not receive dextran 40) (p = 1.00). There was no statistically significant difference in the incidence of thrombotic flap complications between the groups. None of the patients developed acute respiratory distress syndrome or required prolonged ventilator support. No patient had dextran-related anaphylactoid reactions. Thirty-eight patients (43.7%) in Group A had postoperative atelectasis and 21 (25.6%) patients in Group B had this complication (p = 0.01). Six patients in Group A developed postoperative pneumonia, and five patients in Group B developed this complication (p = 0.93).

Conclusions Though dextran 40 did not result in any significant adverse local or systemic complications, it is not useful as a postoperative antithrombotic agent in head and neck oncologic reconstruction with free tissue transfer.

Keywords

low molecular weight dextran - head and neck reconstruction - free flaps - flap survival; thrombosis
 

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