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Embj (139)

Background. The most common complication of microsurgical reconstruction is graft failure secondary to thrombosis. It is clear that thromboprophylaxis is helpful for a successful microsurgery. However, it’s also obvious that thrombosis can’t be avoided in cases of poor microsurgical technique. There is no consensus regarding the use of anticoagulation therapy during and after microsurgery. The authors compared two dif-ferent antithrombotic prophylaxis protocols used in the past ten years, and analyzed the effectiveness and risks of different pharmacological protocols.

Materials and methods. The authors performed a retrospective review of microsur-gical patients operated between 2005-2014 by the same surgical team. 37 patients (Group A) operated between 2005-2010 and 45 patients (Group B) operated between 2011-2014 were selected. The majority of patients had generic and specific risk fac-tors. Different thromboprophylaxis therapies were used in the two groups. While re-viewing medical records, the authors compared Hb values before and after surgery, the free flap success rate, the need for blood transfusions intra and post-op in order to assess the efficacy (failure rate), and safety of the administered antithrombotic thera-pies (bleeding complications).

Results. The pharmacological protocol used for the patients from Group B was more effective and less risky compared to results obtained from Group A. The therapy used in Group B did not increase the risk of bleeding and postoperative blood loss, and the flap success rate in Group B was significantly higher than that of Group A (p<0.000).

Discussion and Conclusion. This study suggests that even in a perfect microanasto-mosis, prothrombotic mechanisms are activated, which lead to flap failure. A reasoned and balanced drug therapy can counteract the natural tendency of pedicle thrombosis, without exposing the patient to bleeding complications. Vasoactive drugs, although still experimental in microsurgery, may be used in the near future in order to further improve the success rates of free flaps.


Labyrinthine fistula is a complication of ear cholesteatoma that increase the risk of sensorineural hearing loss. The management of the fistula must be done contextually with mastoidectomy by: leaving cholesteatoma matrix over the fistula, or remove the matrix reconstructing the defect. Objective : analysis of the two techniques to treat labyrinthine fistula. Methods : retrospective review with case series analysis. Results: a labyrinthine fistula was present in 14% of cholesteatoma patients; CT scan was predictive in all cases; the hearing preservation was obtained with both techniques; a recurrence was detected only in one case; postoperative nystagmus incidence was higher in those cases with matrix left in situ and when the size of the fistula was larger than 2 mm. Conclusions : the labyrinthine fistula have to be treated contextually with cholesteatoma removal, both techniques had good postoperative hearing preservation rate. The postoperative vertigo with nystagmus is more frequent in larger fistulas. 


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