GP2d - Does Tranexamic Acid (TXA) Influence Postoperative Wound Healing in Orthognathic Surgery?

Abstract:
Statement of the Problem:Tranexamic acid (TXA) is an antifibrinolytic agent utilized in surgical procedures and hemostatic disorders to prevent the deterioration of blood clots and aid hemostasis. TXA has been proven effective in reducing intraoperative and postoperative bleeding and may be beneficial to wound healing after surgery.¹ Reports of topical TXA impeding wound healing however call into question the validity of this statement.² In addition, others have not found intravenous TXA to be effective in reducing wound complications. This study aims to characterize the impact of TXA on intraoral wound healing following orthognathic surgery.
Materials and

Methods: This retrospective study assessed subjects who underwent orthognathic surgery between January 1, 2021, and December 31, 2024, within the Department of Plastic and Oral Surgery at Boston Children’s Hospital. Hospital records were queried using CPT codes to identify eligible patients. Patients met inclusion criteria if they underwent an orthognathic procedure (Le Fort I [LF1], bilateral sagittal split osteotomy [BSSO], or bimaxillary procedure involving both a LF1 and BSSO [BiMax]). Patients undergoing re-do orthognathic procedures were excluded from this study.
The primary predictor variable was intraoperative administration of TXA. Dosing of TXA was dependent upon patient weight. A bolus of 10 mg/kg over 10 minutes was given at induction followed by maintenance dosing of 5 mg/kg/hr. The primary outcome variable was the presence of an early wound healing complication occurring within 6 weeks of the date of the procedure. This was further defined as the presence of wound dehiscence, granulation tissue along the incision site, or a surgical site infection (SSI).
Methods of Data Analysis: Descriptive statistics were calculated. Independent Samples T-tests, Fisher’s Exact tests and Chi-Square tests were used to analyze associations between variables and outcomes. A P value less than .05 was considered significant.

Results and Outcomes Data
A total of 320 subjects underwent an orthognathic operation during the study period. The mean age was 19.79 years ± 3.69 years and the sample was 52.5% female (n = 168). Of the procedures performed, 41.9% underwent a Le Fort I (n = 134), 14.7% underwent a BSSO (n = 47), and 43.4% underwent a BiMax (n = 139). Intra-operative TXA administration occurred in 60.3% of subjects (n = 193). Wound healing issues were observed in 11.9% of subjects who received TXA (n = 23) and 11.0% of subjects who did not receive TXA (n = 14) (P = .423). All instances of wound healing issues in subjects whom received TXA occurred at mandibular sites. There was only one instance of a maxillary wound healing complication which occurred in a subject who did not receive TXA. Subsequent hardware removal occurred in 30.4% of subjects who received TXA and had a wound healing complication (n = 7) compared to 28.6% of subjects who did not receive TXA (n = 4) (P = .818). Subjects who underwent a BSSO (21.2%, n = 10) and BiMax (18.0%, n = 25) experienced significantly greater rates of wound healing issues compared to subjects who underwent an isolated Le Fort I osteotomy (1.5%, n = 2) (P < .001). Age and sex did not demonstrate a significant impact on wound healing issues.

Conclusions: TXA did not demonstrate any significant advantage nor detriment to intraoral wound healing following orthognathic surgery. BSSO incisions appear to be more prone to wound healing complications.

References:
1. Xu JW, Qiang H, Li TL, Wang Y, Wei XX, Li F. Efficacy of topical vs intravenous tranexamic acid in reducing blood loss and promoting wound healing in bone surgery: A systematic review and meta-analysis. World J Clin Cases. 2021;9(17):4210-4220. doi:10.12998/wjcc.v9.i17.4210.
2. Yalamanchili S, Talei B, Azizzadeh B, Auersvald A, Frankel AS. Wound Healing Complications With Tranexamic Acid: Not the Silver Bullet After All. Aesthet Surg J. 2023 Nov 16;43(12):1409-1415.