Free Flap Survival Following Failure of the Vascular Pedicle

Jay Granzow, Andrew I. Li, Amy Caton, J. Brian Boyd

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Controversy exists regarding whether or not, or, if so, how quickly free flaps can achieve neovascularization from the surrounding tissue bed and independence from the vascular pedicle. In this paper, we document the survival of free flaps despite early vascular pedicle thrombosis and review the literature regarding the period of time believed to be required for flap autonomy to occur. Design: Case series Setting: Harbor-UCLA Medical Center Patients: We report 3 cases in which pedicle failures occurred within 2 weeks of free flap transfer. The first patient suffered repeated leaks from the vascular anastomosis with hematoma formation occurring on postoperative days 4, 6, and 17, ultimately requiring ligation of the pedicle. The second patient developed a salivary leak and accumulation of saliva around the pedicle, which was found thrombosed on postoperative day 11. The third patient lost Doppler signals from the pedicle on postoperative day 7 and 8, each occasion necessitating a return to the operating room for anastomotic revision. However, on postoperative day 9, the signal was lost yet again and no further revisions were attempted. Results: Two of the 3 flaps survived completely and the third was noted to have near complete survival. Conclusion: Microvascular free flaps can survive despite complete pedicle failure as early as 10 days after surgery. The mechanism behind this may involve the process of neovascularization. We conclude that early free flap pedicle failure does not necessarily equate to complete flap loss.

Original languageEnglish (US)
Pages (from-to)44-48
Number of pages5
JournalAnnals of plastic surgery
Volume75
Issue number1
DOIs
StatePublished - Jul 25 2015
Externally publishedYes

Fingerprint

Free Tissue Flaps
Blood Vessels
Thrombosis
Operating Rooms
Ambulatory Surgical Procedures
Saliva
Hematoma
Ligation
Survival

Keywords

  • flap autonomy
  • free flap
  • neovascularization
  • pedicle failure

ASJC Scopus subject areas

  • Surgery

Cite this

Free Flap Survival Following Failure of the Vascular Pedicle. / Granzow, Jay; Li, Andrew I.; Caton, Amy; Boyd, J. Brian.

In: Annals of plastic surgery, Vol. 75, No. 1, 25.07.2015, p. 44-48.

Research output: Contribution to journalArticle

Granzow, Jay ; Li, Andrew I. ; Caton, Amy ; Boyd, J. Brian. / Free Flap Survival Following Failure of the Vascular Pedicle. In: Annals of plastic surgery. 2015 ; Vol. 75, No. 1. pp. 44-48.
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