(436) Role of dextran-40 in Pedicled Flap Head and Neck Reconstruction

Introduction: To evaluate the efficacy of low molecular weight dextran in pedicled flap reconstruction of oromandibular defect post primary excision of oral malignant lesions.

Methods: Study

Design: Single-arm, randomized control trial
Study Setting: The trial was conducted in the department of Otorhinolaryngology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar
Participants: Biopsy proven patients with oral malignancy where surgical treatment with pedicled flap reconstruction was planned.
Intervention: Postoperatively, patients randomized in dextran-40 arm received low molecular weight dextran at 30ml/hour as continuous infusion for 72 hours postoperatively.
Outcome: Flap survival was primary outcome amongst the two groups. Effect of dextran on haemodynamic parameters and calculation of drain output in respective arm was secondary objective of the study.

Results: Numbers Randomized: Total 44 patients with 22 in each arm
Number analysed: 22 participants in each group
Outcomes: There were total of two flap failures in form of superficial partial thickness necrosis and one full thickness partial necrosis in control arm (86.36% survival). In dextran-40 arm, only one patient had superficial partial thickness necrosis (95.45% survival). The p-value calculated for flap survival on POD1, 3 and 7 were 1.00, 0.607 and 0.607 respectively. On comparing haemodynamic parameters between preoperative and postoperative values in both the groups (control and dextran 40), p-value for haemoglobin, albumin and total protein were 0.05, 0.057 and 0.384 respectively.

Conclusions: This randomised controlled trial shows improvement in flap survival in dextran group, but the difference is not significant statistically (three failures in control vs one in dextran group). No systemic or flap related complications were encountered in dextran-40 arm. It can be used in postoperative period safely unless contraindicated as it is a safe drug proven from our trial. It can be used as an adjunct antithrombotic agent, in cases where early flap failure is evident in early postoperative period.