Delayed Free Flap Salvage After Venous Thrombosis

The incidence of free flap failure is reported at 4% to 5%,but pedicle thrombosis occurs in a higher percentage, with the difference resulting from successful salvage of failing flaps. Often, these failures are attributed to postoperative venous thrombosis with salvage reported at 42%. The venous engorgement of the flap and the resulting microvascular changes lead to a more rapid and less reversible no-reflow phenomenon established within 6 hours. However, this report shows successful free flap salvage with thrombolytic drugs after 6 hours, highlighting that the mechanisms of free flap failure are still poorly understood.