Sildenafil effect on prevention of thrombosis after microsurgical anastomosis: experimental rat model of thrombotic suture.

INTRODUCTION: Thrombosis of vascular anastomosis in the field of reconstructive microsurgery is a clinical problem of extraordinary importance for the devastating consequences for affected patients. Sildenafil has been shown to be relaxing vascular action on the peripheral vascular system in vivo and have an ability to reduce platelet aggregation. There is no study up to date on the effect of sildenafil on microvascular anastomosis, neither experimental studies nor clinical settings. MATERIAL AND METHODS: A purposeful thrombotic back-wall stitch was performed in the groin flap pedicle to obtain an anastomosis with thrombotic potential where the drug effect was studied. RESULTS: Data in the experimental group treated with papaverine or sildenafil indicate a considerable decrease in the percentage of necrotic flaps (20% necrotic flaps in papaverine group versus 30% necrotic flaps in sildenafil group) in comparison with control group (60% necrotic flaps). In papaverine group, in 100% cases, flap necrosis was established in the first 24 h, but in sildenafil group, 66% flap necrosis was established between the second and the seventh postoperative days. CONCLUSION: The study did not demonstrate significant differences between the groups, but it does suggest a benefit in applying papaverine and sildenafil in the anastomosis with already thrombogenetic disease, compared to the nonapplication of antithrombotic drugs. The establishment of thrombosis in the necrotic flaps in the group treated with sildenafil was later than in the group treated with papaverine, with a statistical trend but without becoming significant.

Anticoagulación en microcirugía reconstructiva en los servicios de Cirugía Maxilofacial en España / Anticoagulation in reconstructive microsurgery in maxillofacial surgery departments in Spain

Objetivo. Conocer el protocolo de terapia anticoagulante que siguen en el perioperatorio de este tipo de intervención los principales servicios de Cirugía Oral y Maxilofacial de España que realizan microcirugía reconstructiva de cabeza y cuello. A partir de aquí, resumir la terapia anticoagulante mayoritaria e intentar unificar criterios. Material y métodos. Los autores realizan un estudio descriptivo tras contactar a través de encuesta telefónica y/o por correo electrónico con los principales servicios de Cirugía Oral y Maxilofacial de los hospitales en España en los que se realiza cirugía reconstructiva con injertos libres microvascularizados. Resultados. De los 65 servicios de Cirugía Oral y Maxilofacial de España, 29 (44%) son los integrantes del estudio. El resto de servicios se excluyen por no realizar regularmente reconstrucción microquirúrgica o no notificar los resultados de la encuesta. De estos 29 servicios participantes, 22 (73%) siguen un protocolo de antitrombosis en los procedimientos microquirúrgicos. Conclusión. Pese a no existir una pauta estandarizada de antitrombosis, hay datos concluyentes de que el dextrano no debe utilizarse por el alto riesgo de complicaciones sistémicas, así como de que los únicos fármacos que han conseguido una reducción de la trombosis microvascular son la heparina y el AAS con respecto a la ausencia de terapia antitrombótica(AU)

Objective. To find out the protocol for anticoagulation therapy in the perioperative period following microvascular reconstruction in major Oral and Maxillofacial Surgery Departments in Spain. From this, to summarise the majority anticoagulant therapy and attempt to unify criteria. Material and Methods. The authors conducted a descriptive study. A survey was performed contacting by telephone and/or email with the major Oral and Maxillofacial Surgery departments in Spain who perform reconstructive surgery with microvascular free flaps. Results. Of the 65 services of Oral and Maxillofacial Surgery Departments in Spain, 29 (44%) participated in the study. The other services were excluded owing to not practicing microsurgical reconstruction or not providing the results of the questionnaire. Of these 29 participating departments, 22 (73%) followed an antithrombotic protocol in microsurgical procedures. Conclusion. Despite the lack of a standardised antithrombotic pattern there is evidence that dextran should not be used due to the high risk of systemic complications, and heparin and aspirin are the only drugs that have achieved a reduction in microvascular thrombosis compared to the absence of antithrombotic therapy(AU)