Investigation of Antithrombotic Drug Effects on Preventing Thrombosis Emerging in Gluteus Maximus Flaps before Anastomosis

Aim of this study was to investigate the effects of thromboprophylactic agents at pre-anastomotic period of thrombosis in gluteus maximus muscle flaps. Forty five male Sprague-Dawley rats that have 289 g average weight   were randomly diveded into 9 experiment groups and, each group was consisted of five rats. The first group was a control (sham) and not treated with antithrombotic agents. The other groups were consisted of rats treated with SC heparin, SC LMWH, oral aspirin and the combinations of these groups with IV heparin, and only treated with IV heparin and flaps of these groups were washed with % 10 heparin solution. For the ninth group, we didn’t give any thromboprophylactic agents but washed flaps with % 10 heparin solution. The presence of fibrinogen, vWf and the thrombomoduline were investigated in the flap tissues. A diffuse thrombosis was evaluated in the sham group. There was found the lowest thrombosis findings in SC heparin group. A mild to moderate degree of thrombosis was seen in the SC LMWH, oral aspirin or IV heparin injected group. In this animal model, preoperative SC heparin treatment has significant thrombroprophylactic effect when used alone but not in combination.

Investigation of Antithrombotic Drug Effects on Preventing Thrombosis Emerging in Gluteus Maximus Flaps before Anastomosis

Aim of this study was to investigate the effects of thromboprophylactic agents at pre-anastomotic period of thrombosis in gluteus maximus muscle flaps. Forty five male Sprague-Dawley rats that have 289 g average weight   were randomly diveded into 9 experiment groups and, each group was consisted of five rats. The first group was a control (sham) and not treated with antithrombotic agents. The other groups were consisted of rats treated with SC heparin, SC LMWH, oral aspirin and the combinations of these groups with IV heparin, and only treated with IV heparin and flaps of these groups were washed with % 10 heparin solution. For the ninth group, we didn’t give any thromboprophylactic agents but washed flaps with % 10 heparin solution. The presence of fibrinogen, vWf and the thrombomoduline were investigated in the flap tissues. A diffuse thrombosis was evaluated in the sham group. There was found the lowest thrombosis findings in SC heparin group. A mild to moderate degree of thrombosis was seen in the SC LMWH, oral aspirin or IV heparin injected group. In this animal model, preoperative SC heparin treatment has significant thrombroprophylactic effect when used alone but not in combination.

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  • Kojima T, Saito H. Hypercoagulable States. In: Tanaka K, Davie EW, (Eds.) Recent Advances in Thrombosis and Hemostasis. Hong Kong: Springer; 2008. P. 507-520.
  • Conrad MH, Adams WP Jr. Pharmacologic optimization of microsurgery in the new millennium. Plast Reconstr Surg 2001; 108(7):2088-2096.
  • Xipoleas G, Levine E, Silver L, Koch RM, Taub PJ. A survey of microvascular protocols for lower-extremity free tissue transfer I: perioperative anticoagulation.Ann Plast Surg 2007; 59(3):311-315.
  • Bayramicli M. Deneysel Mikrocerrahi. Istanbul: Argos İletisim Hizmetyeri Reklamcılık ve Tic. AS; 2005. 520-523.
  • Ching S, Thoma A, Monkman S, Kelton JG. Inhibition of microsurgical thrombosis by the platelet glycoprotein IIb/IIIa antagonist SR121566A. Plast Reconstr Surg 2003; 112(1):177-185.
  • Esclamado RM, Carroll WR. The pathogenesis of vascular thrombosis and its impact in microvascular surgery. Head Neck. 1999; 21(4):355-362.
  • Andresen DM, Barker JH, Hjortdal VE. Local heparin is superior to systemic heparin in preventing arterial thrombosis. Microsurgery.2002; 22(6):265-272.
  • Weksler BB, Pett SB, Alonso D, Richter RC, Stelzer P, Subramanian V, Tack- Goldman K, Gay WA Jr. Differential inhibition by aspirin of vascular and platelet prostaglandin synthesis in atherosclerotic patients. N Engl J Med 1983; 308(14):800- 805.
  • Chien W, Varvares MA, Hadlock T, Cheney M, Deschler DG. Effects of aspirin and low-dose heparin in head and neck reconstruction using microvascular free flaps. Laryngoscope 2005; 115(6):973-976.
  • Peter FW, Franken RJ, Wang WZ, Anderson GL, Schuschke DA, O'Shaughnessy MM, Banis JC, Steinau HU, Barker JH. Effect of low dose aspirin on thrombus formation at arterial and venous microanastomoses and on the tissue microcirculation. Plast Reconstr Surg 1997; 99(4):1112-1121.
  • Norgren L. Can low molecular weight heparin replace unfractionated heparin during peripheral arterial reconstruction? An open label prospective randomized controlled trial. J Vasc Surg 2004; 39(5):977-984.
  • Samama CM, Gigou F, Ill P. Low-molecular-weight heparin vs. unfractionated heparin in femorodistal reconstructive surgery: a multicenter open randomized study. Enoxart Study Group. Ann Vasc Surg 1995; 9S:45-53.
  • Hadlock TA, Kim J, Deschler DG. The effect of subcutaneously administered low- molecular-weight heparin on microarterial thrombosis in the rat. Arch Facial Plast Surg 2003; 5(1):36-39.
  • Montalescot G, White HD, Gallo R, Cohen M, Steg PG, Aylward PE, Bode C, Chiariello M, King SB 3rd, Harrington RA, Desmet WJ, Macaya C, Steinhubl SR. Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. N Engl J Med 2006; 7;355(10):1006-1017.