Impact of Tranexamic Acid on Head and Neck Free Flap Outcomes: A Retrospective Cohort Analysis

ABSTRACT Objective Tranexamic acid (TXA) is an antifibrinolytic agent studied for its role in reducing perioperative bleeding. While it has shown promise in operations requiring free tissue transfer in plastic surgery, its application in head and neck free flap reconstruction is less documented. This study evaluates the impact of TXA on head and neck free flap surgery outcomes. Methods This was a single‐institution retrospective cohort study of adult patients who underwent head and neck reconstruction with autologous free tissue transfer between May 2023 and October 2024. Multivariable logistic regression and linear regression were used to evaluate differences between groups. Odds ratios and 95% confidence intervals were used to describe associations. Results A total of 215 patients were included (15.3% receiving TXA). Patients who received TXA had a higher rate of intraoperative transfusions ( p = 0.049). This difference was not observed after adjustment for other factors ( p = 0.21). Patients who received TXA had a more stable hemoglobin at Postoperative Day (POD) 1 (−1.84 ± 1.62 vs. −2.77 ± 1.36 g/dL, p = 0.045), however, this difference resolved by POD 7 with no difference in postoperative transfusion rates ( p = 0.22). There was no difference in postoperative recipient site, donor site, or medical complications between groups. Conclusions Head and neck free flap patients that received TXA had no significant difference in flap outcomes or major thrombotic events. Our results suggest that TXA is a safe option among patients undergoing free tissue transfer for head and neck reconstruction. Further prospective research with larger cohort sizes is needed to elucidate potential benefits. Level of Evidence 3.