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Head and Neck Surgery

(289) Ketorolac for Prevention of Microvascular Thrombosis in Free Flaps

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Introduction: Prevention of microvascular thrombosis in free tissue transfer for head and neck reconstruction is paramount to maintaining a viable reconstruction. Various anti-thrombotic agents have been used in the past for this purpose. The aim of this study is to show the non-inferiority of Ketorolac for prevention of flap failure.

Methods: This is a retrospective review of all head and neck free tissue transfers performed at a quaternary care center by the two senior authors who routinely use ketorolac for prevention of microvascular thrombosis. Patients who were ineligible to receive ketorolac were included in the study for descriptive purposes.

Results: From 2010 – 2020, there were 322 patients who underwent free tissue transfer of the head and neck. Within the cohort, 278 patients were administered ketorolac and 44 were not, most commonly due to kidney dysfunction or cardiac comorbidities requiring aspirin. Within the ketorolac group, the flap failure rate was 2.5% with a venous and arterial thrombosis incidence of 2.2% and 1.4% respectively. Hematoma incidence was 9.4% in ketorolac group and 6.8% in non-ketorolac group. Rate of acute kidney injury was 3.6% in ketorolac group and 11.4% in non-ketorolac group.

Conclusions: This is the largest study of ketorolac usage in head and neck free tissue transfer patients. The flap failure rate of 2.5% is comparable to the literature rate of 5% (p value 0.054). Ketorolac was not associated with increased rate of acute kidney injury when used in patients without kidney dysfunction. The incidence of hematoma is slightly higher than previous studies; however, 23% of hematoma patients received ketorolac and full dose anticoagulation such as a heparin drip. Ketorolac in combination with other full dose anticoagulants may lead to increased risk of hematoma. This study demonstrates the safety and efficacy of ketorolac for prevention of microvascular thrombosis and free flap failure in head and neck reconstruction patients.