유리피판술에서 덱스트란의 사용이 필요한가?

Abstract

PURPOSE Low-molecular-weight dextran is one of the most frequently used antithrombotic agents in microvascular surgery, but there is controversy whether it has the real benefit in the clinical aspects or not. The purpose of this study is to evaluate the effect associated with postoperative use of low-molecula-weight dextran in breast reconstruction by free TRAM flap patients. METHODS: From January 2002 to October 2008, we reconstructed 88 cases of postmastectomy deformity using the free TRAM flap. They were divided into two groups: a group with no use of dextran(66 patients, control group, Group A) and a postoperative low-molecular weight dextran loaded group(22 patients, Group B). We assessed number of flap survival, rate of complication like hematoma or seroma, total amount of drainage from operative wound, duration of drainage, and amount of transfusion in each group.

RESULTS There was no total flap loss and every flap was survived. Total amount of drainage on post-operative 5 days were 857mL in group A and 1101mL in group B. Drain was kept for average of 7.3 days in group A and 8.7 days in group B. Packed red cell transfusions were made in average of 3.3 units for group A and 3.0 units for group B. Group B showed significantly higher values in former 2 comparative parameters than group A.

CONCLUSION There was no definitive advantage of anticoagulants in elective free-flap surgery in terms of success rate. However, groups with using anticoagulants had the increased bleeding tendency in immediate postoperative period. The routine use of anticoagulants in elective free-flap surgery should be reconsidered with postoperatively less bleeding and early recovery.