Review ArticlesBevacizumab and Wound-Healing Complications Mechanisms of Action, Clinical Evidence, and Management Recommendations for the Plastic SurgeonSharma, Ketan BA, MPH; Marcus, Jeffrey R. MD, FACS, FAAPAuthor Information From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC. Received December 5, 2011, and accepted for publication, after revision, February 2,2012. Conflicts of interest and sources of funding: none declared. Reprints: Jeffrey Marcus, MD, FACS, FAAP, Department of Surgery, Duke University, DUMC 3974, Durham, NC 27710. E-mail: [email protected]. Both authors have done the study conception and design, acquisition of data, analysis and interpretation of data, and critical revision. The drafting of manuscript was done by Ketan Sharma. Annals of Plastic Surgery: October 2013 - Volume 71 - Issue 4 - p 434-440 doi: 10.1097/SAP.0b013e31824e5e57 Buy Metrics Abstract Reflecting the growing understanding of vascular endothelial growth factor (VEGF) in cancer survival and growth, the anti-VEGF antibody bevacizumab (Avastin) is increasingly used to treat advanced malignancy. However, because VEGF also mediates proper wound healing, bevacizumab may lead to potentially severe wound-healing complications (WHCs). Because bevacizumab expands in use, the plastic surgeon will increasingly be entrusted to manage such WHCs successfully. Therefore, this review summarizes the pathophysiological evidence, systematically reviews the available clinical evidence, and provides management guidelines for bevacizumab-related WHCs. Bevacizumab produces WHCs by disrupting vasodilation, increased vascular permeability, and angiogenesis. Current clinical evidence suggests that bevacizumab may increase WHC risk. This risk seems higher with neoadjuvant than adjuvant bevacizumab use and may be decreased by extending the bevacizumab-surgery interval. Further research is required to quantify the exact bevacizumab-related WHC incidence and optimize the bevacizumab-surgery interval. We propose management guidelines for bevacizumab-related WHCs by indication that should be integrated with clinical judgment, input from the oncology team, and patient wishes when making therapeutic decisions. Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.