Free tissue transfer has become a popular technique for soft tissue defect reconstruction in
head and neck cancer ablation. Although high success rates and good reliability of
free flaps are proven, microvascular
thrombosis is still the most critical issue for microsurgeons. Pharmacological
antithrombotic agents are widely used but their efficacy is still debated. In this study, we analyzed whether prostaglandin-E1 (
PGE1) and dextran-40 can improve the outcomes compared to no antithrombotic
therapy at all. We retrospectively reviewed 1,351
free flaps performed for head and neck reconstruction after
cancer ablation. Three groups defined were 232 flaps received
PGE1, 283 flaps received dextran-40, and 836 received no antithrombotic
therapy. The demographics of these three groups indicated no statistical differences. The results showed that flap survival revealed no significant difference among
PGE1, dextran-40, and control group (P = 0.734). There was a tendency to
hematomas in
PGE1 group (P = 0.056) when compared with other two groups. Dextran-40 significantly increased flap failure rate in high-risk patients with
diabetes mellitus (P = 0.006) or
hypertension (P = 0.003), when compared with
PGE1 and control group. These results revealed antithrombotic
therapy with
PGE1 and dextran-40 do not determine a significant improvement in flap survival.