An Assessment of Pharmacologic Deep Vein Thrombosis Prophylaxis on Head and Neck Free Flap Outcomes

Tuesday, October 14, 2025

8:42 AM - 8:48 AM EDT

Location: 128

Disclosure(s):

Robert E. Africa, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Amber M. Dunmire, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The purpose of this study is to compare free flap outcomes based on pharmacologic deep vein thrombosis (DVT) prophylaxis on the same day and postoperatively after bony or non-bony free flap reconstruction.

Methods: This retrospective cohort study utilizes de-identified patient data from 68 health care organizations from the TriNetX database in the United States from January 1, 2010 to January 1, 2024 to evaluate differences in free flap outcomes. The data include patients older than 18 years with head and neck cancer who received free flap reconstruction with or without DVT prophylaxis. Outcomes were flap failure, blood vessel repair, flap revision, rate of DVT, pulmonary embolism (PE), and cardiopulmonary complications. Rates of outcomes were measured by relative risk (RR) with 95% confidence interval (CI).

Results: A total of 5,145 patients with DVT prophylaxis on the same day of reconstruction were included, while 5,406 patients received prophylaxis in the postoperative period. There was no significant difference for the same day bony or non-bony reconstruction in the rates of flap failure (RR: 0.95; 95% CI: 0.75-1.20), blood vessel repair (RR: 0.96; 95% CI: 0.82-1.12), or flap revision (RR: 0.96; 95% CI: 0.84-1.09). In the postoperative groups, the rates of flap failure (RR: 0.66; 95% CI: 0.59-0.75) and flap revision (RR: 0.65; 95% CI: 0.57-0.73) for the bony reconstruction cohort that did not receive DVT prophylaxis were significantly elevated. Flap failure and revision rates were significantly elevated for the non-DVT prophylaxis cohort among patients receiving non-bony reconstruction group (RR: 0.75; 95% CI: 0.69-0.79, RR: 0.71; 95% CI: 0.66-0.77). The rate of PE and DVT in all groups was not statistically different, but non-bony reconstruction without DVT prophylaxis had a significantly higher rate of cardiovascular complications in the postoperative period (RR: 0.63; 95% CI: 0.45-0.88).

Conclusions: Pharmacologic DVT prophylaxis administration in the postoperative period for both bony and non-bony head and neck free flaps is associated with a decreased risk of flap failure and revision.

Presenting Author(s)

Robert E. Africa, MD

Resident
University of Texas Medical Branch Hospitals
Galveston, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Shahrukh R. Ali, MD

Resident
University of Texas Medical Branch Hospitals
Richmond, TX, United States

Disclosure information not submitted.
Amber M. Dunmire, MD

Resident
University of Texas Medical Branch Hospitals
Galveston, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Sepehr Shabani, MD

Assistant Professor
City of Hope National Medical Center
Duarte, California, United States

Disclosure information not submitted.
Orly M. Coblens, MD

Associate Professor & Residency Program Director
University of Texas Medical Branch Hospitals
Galveston, Texas, United States

Disclosure information not submitted.

Senior Author(s)

Viran J. Ranasinghe, MD

Assistant Professor
University of Texas Medical Branch
Galveston, TX, United States

Disclosure information not submitted.