Use of Tranexamic Acid to Reduce Bleeding in Head and Neck Reconstructive Surgery

Abstract

Objective: To assess the effectiveness of local infiltration of tranexamic acid in reducing intraoperative bleeding in head and neck reconstruction.

Methodology: This prospective study was conducted at Pakistan Institute of Medical Sciences/ Shaheed Zulfiqar Ali Bhutto Medical University between April and October 2024. Sixty six patients undergoing reconstructive surgery for head and neck defects were allocated into two groups: one receiving local infiltration with a 1:1 mixture of lignocaine (20 mg/ml) and TXA (100 mg/ml), and the other receiving a 1:1 mixture of lignocaine (20 mg/ml) and normal saline. Surgical field hemostasis was graded, postoperative hemoglobin drop was measured at 48 hours, and transfusion needs were recorded. Statistical analyses were performed to compare the results of the groups.

Results: The tranexamic acid group demonstrated significantly better surgical field visibility (mean score 1.85 vs. 3.24, p < 0.01), a lower mean hemoglobin drop at 48 hours (0.53 g/dl vs. 1.42 g/dl, p < 0.01), and reduced transfusion requirements (1 vs. 12 patients). No significant adverse effects were observed during the immediate postoperative period.

Conclusions: Local infiltration of tranexamic acid reduces intraoperative bleeding, improves surgical field visibility, and decreases transfusion requirements without immediate adverse effects. Further studies are recommended to optimize dosing and assess long-term safety.

Keywords: Tranexamic acid, head and neck surgery, reconstructive surgery, bleeding control, local infiltration, surgical hemostasis, intraoperative bleeding, antifibrinolytic agents, surgical field visibility.