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Program Number: B290
Session Name: Poster Session
Ischemic Time does not increase complications in Microvascular Free Tissue Transfer. Is Heparin the key to attenuating Ischemia Reperfusion Injury?
Connor O'Meara, MD, PhD1; Jessica Lin
2; Osama Hamdi, MD
3; Bruce Langford, MD
4; M Dougherty, MD
5; Madisyn Primas, MD
6; Amber Denner, MD
7; Levon Khachigian, PhD
8; Eric Dowling, MD
9; Jonathan Garneau, MD
1; David C Shonka, MD
9; Mark Jameson, MD
10; Katherine Fedder, MD
9;
1Division of Head & Neck Oncology and Microvascular Reconstruction, Department of Otolaryngology, Head & Neck Surgery, University of Virginia Health Services, Charlottesville, VA, 22903;
2University of Virginia School of Medicine, Charlottesville, VA, USA, 22903;
3Department of Otolaryngology, Head & Neck Surgery, University of Colorado Hospital, Aurora, CO, 80045;
4ENT Associates of East Texas, 1136 E Grande Blvd, Tyler, TX, 75703;
5Department of Otolaryngology, Head & Neck Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239-3098;
6Department of Surgery, Northwestern University, 676 N. St Clair St., Suite 2320, Chicago, IL, 60611;
7Department of Obstetrics and Gynecology, University of Virginia Health Sciences, Charlottesville, VA, 22903;
8Vascular Biology and Translational Research, Department of Pathology, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia;
9Division of Head & Neck Oncology and Microvascular Reconstruction, Department of Otolaryngology, Head & Neck Surgery, University of Virginia Health Services, Charlottesville, VA, USA, 22903;
10Avera Medical Group ENT- Head & Neck Surgery, 1417 S Cliff Ave, Suite 300 in Plaza 1, Sioux Falls, SD, 57105
Background: Microvascular free tissue transfer (MVFTT) harvest requires a period of ischemia, prior to reperfusion. The accepted theory is that prolonged ischemia increases risk of MVFTT complication/failure, attributed to ischemia reperfusion injury (IRI). We aimed to determine a causal relationship between ischemia time and MVFTT complications or failure.
Methods: A 10-year, single institution, retrospective analysis of patients undergoing Head & Neck MVFTT was performed. Comparisons were made to determine association between MVFTT ischemic time and failure, complications, return to theatre and length of stay (LOS).
Results: From 414 MVFTTs; failure, Return to Operating Theatre (rOT), complication rate and Length of Stay (LOS) were 1.0%, 11.8%, 21.7% and 7.889 ± 6.35 days, respectively. Mean and maximum ischemia times for successful MVFTTs were 175.3 ± 71 min and 510 min. Prior irradiation, osteocutaneous MVFTT and intraoperative complications; significantly increased ischemia. Association between ischemia time and specific complications, or failure, was not identified.
Conclusions: Duration of ischemia may not influence MVFTT failure or complications. We routinely utilize intra-operative Heparin, and a standardized Heparin infusion protocol, for salvage MVFTT cases. Our understanding of the protective microvascular effects of Heparin, independent of its anti-coagulant ability, is expanding. We propose that Heparin may play a key therapeutic role in MVFTT, given new insight into the pathophysiology of IRI.
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