A Survey of Microvascular Protocols for Lower-Extremity Free Tissue Transfer I

In Brief Reconstruction of the lower extremity using free tissue transfer is performed throughout the country by numerous surgical teams. However, no established protocol exists for the use of anticoagulation in the perioperative period. The present study sought to analyze trends in current protocols regarding perioperative anticoagulation for lower-extremity free flap reconstruction. Members of the American Society of Plastic Surgeons were surveyed with regard to their preferences for perioperative anticoagulation in conjunction with lower-extremity free tissue transfer. The results demonstrated tremendous variability in both the agents used and therapeutic periods employed. They highlighted the absence of 1 or more common anticoagulation protocols and tried to establish common trends in the use of such agents. In an e-mail survey of ASPS members, 98 responses were received from those regularly performing lower-extremity microvascular reconstruction. A total of 84% used some form of anticoagulation before, during, or after surgery, but little uniformity in protocol was noted.