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The Effects of Ketorolac on Microvascular Thrombosis in Lower Extremity Reconstruction

Lee, Kyeong Tae M.D.; Jeon, Byung-Joon M.D.; Lim, So-Young M.D.; Pyon, Jai-Kyung M.D.; Bang, Sa-Ik M.D.; Oh, Kap-Sung M.D.; Mun, Goo-Hyun M.D.

Plastic and Reconstructive Surgery: June 2012 - Volume 129 - Issue 6 - p 1322–1327
doi: 10.1097/PRS.0b013e31824ec33f
Reconstructive: Lower Extremity: Original Article
Basic

Background: Ketorolac is commonly prescribed for relieving postoperative pain and is known to have an anticoagulation effect, though this has not been studied in a clinical series. The aim of this study was to evaluate the effects of ketorolac on microvascular thrombosis in lower extremity reconstruction.

Methods: A retrospective chart review was performed for patients who underwent lower limb reconstruction with a free flap between January of 2005 and September of 2011. Patients were categorized into two groups based on the administration of ketorolac for postoperative pain relief. Complications were assessed, and the two groups were compared for vascular insufficiency, total or partial flap loss, and hematoma formation.

Results: A total of 128 patients underwent microsurgical flap transfer, including 111 thoracodorsal artery perforator flaps, four latissimus dorsi myocutaneous flaps, seven deep inferior epigastric artery perforator flaps, and six anterolateral thigh flaps. Eighty patients were administrated ketorolac, and 48 patients were not. The nonketorolac group had significantly higher rates of vascular-related complications, and the difference remained significant after adjusting for confounding factors on multivariate logistic regression analysis. There was a correlation between the duration of ketorolac administration and complication rates, for which longer periods of ketorolac administration yielded lower complication rates.

Conclusion: Ketorolac administration has a protective effect against the development of microvascular thrombosis and can be a preferred analgesic in free tissue transfer.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Seoul, South Korea

From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.

Received for publication September 16, 2011; accepted December 15, 2011.

Disclosure: The authors have no financial interest in any of the products, devices, or drugs mentioned in this article.

Goo-Hyun Mun, M.D.; Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, South Korea 135-710, supramicro@gmail.com

©2012American Society of Plastic Surgeons