Abstract
Early pedicle occlusion following microvascular flap transfer is the major cause for flap loss, which is most often surgery-associated and occurs usually within the first 48 h postoperatively. In unusual postoperative courses, patient-associated factors (e.g. thrombophilic disposition) have to be investigated. We present a case of posttraumatic reconstruction of a full-thickness skin defect of the foot in a healthy young man with a microvascular flap. At day 4 after surgery, a complete pedicle occlusion of the flap occurred resulting in a removal of the flap. Six days after transfer of another flap, a complete pedicle occlusion occurred as well in the second flap. The second flap survived due to engraftment through neovascularization. Retrospectively, antithrombin deficiency was detected. This case presents flap survival resulting from early engraftment after total pedicle occlusion, indicating the importance of a thorough and focused medical history and specific preoperative investigation if patient history is suspect for coagulopathy.
Level of Evidence: Level V, risk/prognostic study
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Acknowledgments
We would like to acknowledge Georg Moessmer, M.D. (Institute for Clinical Chemistry and Pathobiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany) and Martin Dobritz, M.D. (Institute for Diagnostic and Interventional Radiology Klinikum rechts der Isar, Technische Universität München, Munich, Germany) for medical consulting.
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Hanno Pototschnig, Hans-Günther Machens, Daniel Müller and Yves Harder declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required
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Pototschnig, H., Machens, HG., Müller, D. et al. Free flap engraftment despite early pedicle thrombosis due to antithrombin deficiency. Eur J Plast Surg 38, 499–502 (2015). https://doi.org/10.1007/s00238-015-1114-1
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DOI: https://doi.org/10.1007/s00238-015-1114-1