{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T21:44:00Z","timestamp":1792532640157,"version":"4.5.0"},"reference-count":87,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T00:00:00Z","timestamp":1704240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>This systematic review addresses the crucial role of anticoagulation in microsurgical procedures, focusing on free flap reconstruction and replantation surgeries. The objective was to balance the prevention of thrombotic complications commonly leading to flap failure, with the risk of increased bleeding complications associated with anticoagulant use. A meticulous PubMed literature search following Evidence-Based-Practice principles yielded 79 relevant articles, including both clinical and animal studies. The full-texts were carefully reviewed and evaluated by the modified Coleman methodology score. Clinical studies revealed diverse perioperative regimens, primarily based on aspirin, heparin, and dextran. Meta-analyses demonstrated similar flap loss rates with heparin or aspirin. High doses of dalteparin or heparin, however, correlated with higher flap loss rates than low dose administration. Use of dextran is not recommended due to severe systemic complications. In animal studies, systemic heparin administration showed predominantly favorable results, while topical application and intraluminal irrigation consistently exhibited significant benefits in flap survival. The insights from this conducted systematic review serve as a foundational pillar towards the establishment of evidence-based guidelines for anticoagulation in microsurgery. An average Coleman score of 55 (maximum 103), indicating low overall study quality, however, emphasizes the need for large multi-institutional, randomized-clinical trials as the next vital step.<\/jats:p>","DOI":"10.3390\/life14010082","type":"journal-article","created":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T05:50:38Z","timestamp":1704261038000},"page":"82","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Evidence-Based Approaches to Anticoagulation in Reconstructive Microsurgery\u2014A Systematic Literature Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Niklas","family":"Biermann","sequence":"first","affiliation":[{"name":"Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strau\u00df-Allee 11, D-93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juy Chi","family":"Chak","sequence":"additional","affiliation":[{"name":"Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strau\u00df-Allee 11, D-93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Wiesmeier","sequence":"additional","affiliation":[{"name":"Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strau\u00df-Allee 11, D-93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvan M.","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strau\u00df-Allee 11, D-93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6788-0853","authenticated-orcid":false,"given":"Marc","family":"Ruewe","sequence":"additional","affiliation":[{"name":"Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strau\u00df-Allee 11, D-93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Spoerl","sequence":"additional","affiliation":[{"name":"Clinic and Polyclinic for Oral and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strau\u00df-Allee 11, D-93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1654-7257","authenticated-orcid":false,"given":"Philipp","family":"Kruppa","sequence":"additional","affiliation":[{"name":"Department of Plastic, Hand- and Reconstructive Surgery, Ernst von Bergmann Klinikum Potsdam, Charlottenstra\u00dfe 72, D-14467 Potsdam, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2454-2499","authenticated-orcid":false,"given":"Lukas","family":"Prantl","sequence":"additional","affiliation":[{"name":"Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strau\u00df-Allee 11, D-93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra M.","family":"Anker","sequence":"additional","affiliation":[{"name":"Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strau\u00df-Allee 11, D-93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jormas.2017.03.007","article-title":"Efficacy of the Postoperative Management after Microsurgical Free Tissue Transfer","volume":"118","author":"Sigaux","year":"2017","journal-title":"J. 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