The transverse abdominal island flap —What you should do when the flap turns blue

Summary

Transverse abdominal island flaps often turn blue in the operating room when transferred to the chest wall. Acute blue flaps are caused by venous congestion. In most cases this resolves spontaneously. Persistent venous congestion of the flap, however, is dangerous and must be corrected promptly. This is done by keeping the patient warm, by appropriate dissection around the rib cage and xyphoid process, and by release of tethering and compression of the vascular pedicle. If these fail, a new option of microvascular circulatory augmentation or conversion to a free flap is offered. Methods of prevention and therapeutic management are presented based on our satisfactory experience with approximately 400 patients.