Does Intraoperative Heparin Administration Reduce Postoperative Complications in Deep Inferior Epigastric Perforator Flap Breast Reconstruction?

BACKGROUND

Microsurgical thrombosis is a critical complication of free flap surgery. Evidence evaluating the efficacy of intraoperative thromboprophylaxis in mitigating this complication during deep inferior epigastric perforator (DIEP) flap breast reconstruction remains limited. Here, we report a retrospective analysis of all DIEP flap breast reconstructions performed at our institution during a 6-year period.

METHODS

This single-center analysis offers a retrospective review of all female patients who underwent DIEP flap breast reconstruction from January 2018 to June 2024. Subjects were divided into 2 groups: a control group and a treatment group that received an intraoperative bolus administration of 2000 IU of unfractionated heparin (UFH). Patient characteristics, therapeutic variables, intraoperative details, and postoperative outcomes were extracted and analyzed. Postoperative complications were classified into subgroups: acute complications (≤4 d) and delayed complications (>4 d).

RESULTS

This study included 114 patients (141 breasts), corresponding to 48 patients in the control cohort and 66 patients in the UFH cohort. No significant differences were observed in the occurrence of complications in intraoperative (P = 0.226), acute (P = 0.839), or delayed settings (P = 1.00). Notably, the risk of thrombosis and hematoma was comparable. Interestingly, ischemia time and total operative duration were significantly prolonged in the control group (P < 0.05).

CONCLUSIONS

Intraoperative anticoagulant prophylaxis using UFH did not diminish acute thrombotic complications; however, it was also not associated with an increased risk of hematoma and bleeding. These findings offer valuable insights regarding the clinical relevance and safety profile of perioperative UFH administration.