Background: Tranexamic acid (TXA) has gained popularity across various surgical specialties for reducing perioperative blood loss. However, its role in microsurgery remains underexplored, likely due to concerns that TXA may increase the risk of thromboembolic events and compromise flap viability. Therefore, the aim of this study was to determine the impact of TXA in microsurgical reconstructive procedures.

Methods: A systematic search of the PubMed, EMBASE, Ovid MEDLINE, and Web of Science databases was conducted from their inception to September 21, 2024. Inclusion criteria were retrospective or prospective cohort studies and randomized controlled trials that administered TXA in the context of microsurgical reconstruction. Data on postoperative outcomes were extracted and pooled for meta-analysis.

Results: Five retrospective cohort studies were included, with a total of 718 patients (TXA group: 343 patients; control group: 375 patients). All studies were low-level evidence and retrospective in design, with only one including a matched control group. There was considerable variation across studies in both the microsurgical procedures performed and the timing, dosage, and route of TXA administration. The TXA group did not demonstrate an increased risk of thromboembolic events, showed a significantly decreased mean blood loss, and exhibited a trend toward reduced transfusion and hematoma rates compared to the control group.

Conclusion: Our findings provide low-level evidence that TXA use in microsurgical reconstruction does not increase the risk of thromboembolic events and may help reduce perioperative blood loss, hematoma formation, and transfusion rates. These results offer preliminary support for the safety of TXA in microsurgical reconstruction procedures and highlight its potential benefits for patients at risk of bleeding complications. However, given the limited number, heterogeneity, and low quality of available studies, these findings should be interpreted with caution. Higher-quality research is needed to support the routine use of TXA in microsurgery.

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背景：

氨甲环酸（TXA）在各种外科专科中因其能减少围手术期出血而变得越来越受欢迎。然而，其在显微外科中的作用仍较少被探索，这可能是由于担心 TXA 可能会增加血栓和栓塞事件的风险，并影响皮瓣的存活率。因此，本研究旨在确定 TXA 在显微外科重建手术中的影响。

方法：

从这些数据库的建立之初到 2024 年 9 月 21 日对 PubMed、EMBASE、Ovid MEDLINE 和 Web of Science 数据库进行了系统的搜索。纳入标准为回顾性和前瞻性队列研究以及在显微外科重建中使用 TXA 的随机对照试验。提取并汇总了术后结果数据进行元分析。

结果：

共纳入五项回顾性队列研究，总共有 718 名患者（TXA 组：343 名患者；对照组：375 名患者）。所有研究均为低级别证据的回顾性设计，并且只有其中一项包括了匹配的对照组。在所进行的显微外科手术、TXA 的给药时间、剂量和途径方面，各研究间存在很大的差异。TXA 组并未表现出增加血栓和栓塞事件的风险，平均失血量显著减少，并且输血率和血肿形成率显示出比对照组有所降低的趋势。

结论：

我们的发现提供了低级别的证据，表明在显微外科重建手术中使用 TXA 不会增加血栓和栓塞事件的风险，并可能有助于减少围手术期出血、血肿的形成及输血率。这些结果为 TXA 在显微外科重建中的安全性提供初步支持，并突出了其对有出血并发症风险患者的潜在益处。然而，鉴于现有研究数量有限、异质性大且质量低，应谨慎解读这些发现。需要更高品质的研究来支持在显微手术中常规使用 TXA。

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