Bivalirudin for unsalvageable venous congestion or obstruction in head and neck free flap reconstruction

Micah K Harris; Sophia Dang; Joshua D Smith; Steven Chinn; Shaum S Sridharan; Kevin J Contrera; Matthew E Spector

doi:10.1016/j.oraloncology.2024.107076

Bivalirudin for unsalvageable venous congestion or obstruction in head and neck free flap reconstruction

Oral Oncol. 2024 Oct 14:159:107076. doi: 10.1016/j.oraloncology.2024.107076. Online ahead of print.

Authors

Micah K Harris¹, Sophia Dang¹, Joshua D Smith¹, Steven Chinn², Shaum S Sridharan¹, Kevin J Contrera¹, Matthew E Spector³

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
² Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA.
³ Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: spectorme@upmc.edu.

PMID: 39406013
DOI: 10.1016/j.oraloncology.2024.107076

Abstract

Microvascular free flap surgery permits single-stage reconstruction of complex head and neck ablative defects. Venous congestion can occur in the early postoperative period, risking partial or total flap loss. While prompt surgical re-exploration is often required, a number of adjunct medical treatments have been explored. Recently, there has been an anecdotal rise in the use of the anticoagulant bivalirudin, a recombinant derivative of hirudin. However, there has only been one case series report on the use of bivalirudin in head and neck free flap venous congestion. Here, we describe our team's experience with bivalirudin through a series of 7 patients.

Keywords: Bivalirudin; Free flap; Head and neck; Reconstruction; Venous congestion.

Publication types

Letter