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Safety and clinical outcomes associated with the routine use of tranexamic acid (TXA) in abdominal-based free flap autologous breast reconstruction — a case control study

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Abstract

Background

We present the clinical outcomes associated with the routine use of TXA in free flap breast reconstruction in a single unit. The primary outcome measures were thromboembolic events, hematoma, and seroma. The secondary outcome measure was the length of stay (LOS) of the patients.

Methods

Prospectively collected data of all free flap breast reconstruction performed by the senior author (GAA), where TXA was routinely used, were analyzed. Data were compared to a matched cohort in the same unit, prior to the introduction of TXA. Statistical analysis was performed.

Results

Between April 2018 and March 2020, 100 free flaps were performed on 81 females. The average BMI was 26.26 (range 19.5–32.5). The mean LOS was 3.5 days (range 3–8 days). Three patients (3.7%) were taken back to theaters. One patient had postoperative seroma and 4 flaps (4.9%) suffered minor fat necrosis. There were no cases of complete flap failure and no cases of DVT. The pre-TXA cohort, which included 95 consecutive flaps over the preceding 2 years period, had 2 cases of hematoma, three cases of seroma, and one case of DVT and PE. The TXA cohort had only one case of vessel thrombosis and no total flap loss compared to 4 cases of vessel thrombosis and 3 flap loss in the pre-TXA group. However, there was only a significant statistical difference in the LOS between the two groups favoring the TXA cohort.

Conclusions

Administration of TXA was neither associated with any DVT nor with a risk of pedicle thrombosis or flap loss, when compared to a pre-TXA cohort. Seroma rate (1%) in our cohort was low. The LOS was significantly lower than the pre-TXA cohort. This study highlights the safety of the routine use of TXA in the setting of free flap breast reconstruction.

Level of evidence

Level III, Therapeutic.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Plastic Surgery Department, Southmead Hospital, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK

    Amr Adel Moustafa Moursi & Guirgis Arsanios Awad

  2. Royal Devon and Exeter Hospital, Winford, Exeter, UK

    Mina Ibrahim

  3. Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK

    Guirgis Arsanios Awad

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  1. Amr Adel Moustafa Moursi
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  2. Mina Ibrahim
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Amr Moursi], [Mina Ibrahim] and [GuirgisAwad]. The first draft of the manuscript was written by [Amr Moursi] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Amr Adel Moustafa Moursi.

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Conflict of interest

Amr Moursi, Mina Ibrahim, and Guirgis Awad declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The UK medical research council (MRC) and NHS research ethics committee (NHS REC) guidelines have confirmed that no ethical approval is required.

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Informed consent was obtained from participants in this study.

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The authors have no relevant financial or non-financial interests to disclose.

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Moursi, A.A.M., Ibrahim, M. & Awad, G.A. Safety and clinical outcomes associated with the routine use of tranexamic acid (TXA) in abdominal-based free flap autologous breast reconstruction — a case control study. Eur J Plast Surg 46, 533–540 (2023). https://doi.org/10.1007/s00238-022-02027-z

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