Microvascular
free flaps are key components of reconstructive surgery, but despite their common use and usual reliability, flap failures still occur. Many pharmacological agents have been utilized to minimize risk of flap failure caused by
thrombosis. However, the challenge of most antithrombotic
therapy lies in providing patients with optimal antithrombotic prophylaxis without adverse
bleeding effects. There is a limited but growing body of evidence suggesting that the vasoprotective and anti-inflammatory actions of
statins can be beneficial for
free flap survival. By inhibiting
mevalonic acid, the downstream effects of
statins include reduction of
inflammation, reduced thrombogenicity, and improved vasodilation. This review provides a summary of the pathophysiology of
thrombus formation and the current evidence of anticoagulation practices with
aspirin,
heparin, and
dextran. In addition, the potential benefits of
statins in the perioperative management of
free flaps are highlighted.