Strategies to minimize postoperative complications in microsurgical free tissue transfer: The role of anticoagulation, antiplatelets, and ambulation.

[OBJECTIVE] Microsurgical free tissue transfer (FTT) is essential in reconstructive surgery, but thromboembolic events are a leading cause of flap failure. This study evaluates how perioperative anticoagulation, antiplatelet therapy, and ambulation affect postoperative complications in FTT.

[STUDY DESIGN] A retrospective cohort study of 497 free flap procedures assessed associations between antiplatelet and anticoagulation therapy, ambulation timing, and postoperative outcomes. The cohort included pediatric and adult patients who underwent a free tissue transfer from 2012 to 2021. Multivariable logistic regression identified predictors of flap-related complications.

[RESULTS] Controlling for age, sex, and nicotine use, ambulation on postoperative day 1 was linked to reduced arterial/venous thrombosis (OR 0.34, p ​= ​0.003) and fewer operating room takebacks (OR 0.56, p ​= ​0.006). Anticoagulation on day 6 increased takeback odds (OR 1.64, p ​= ​0.029). Antiplatelet therapy on day 7 decreased takeback odds (OR 0.65, p ​= ​0.04). Day 7 ambulation lowered odds of any complication (aOR 0.67, p ​= ​0.042).

[CONCLUSIONS] Early mobilization and appropriately timed antithrombotic therapy reduce FTT complications, supporting standardized postoperative care.