Skip to main content

Advertisement

Log in

Free flap engraftment despite early pedicle thrombosis due to antithrombin deficiency

  • Case Report
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cierny G 3rd, Byrd HS, Jones RE (1983) Primary versus delayed soft tissue coverage for severe open tibial fractures. A comparison of results. Clin Orthop Relat Res 178:54–63

    PubMed  Google Scholar 

  2. Burns A, Avery BS, Edge CJ (2005) Survival of microvascular free flaps in head and neck surgery after early interruption of the vascular pedicle. Br J Oral Maxillofac Surg 43:426–427

    Article  CAS  PubMed  Google Scholar 

  3. Godden DR, Thomas SJ (2002) Survival of a free flap after vascular disconnection at 9 days. Br J Oral Maxillofac Surg 40:446–447

    Article  CAS  PubMed  Google Scholar 

  4. Machens HG, Pallua N, Pasel J, Mailaender P, Liebau J, Berger A (1998) Persistence of pedicle blood flow up to 10 years after free musculocutaneous tissue transfer. Plast Reconstr Surg 101:719–726

    Article  CAS  PubMed  Google Scholar 

  5. Gundeslioglu AO, Selimoglu N, Toy H, Koç O (2013) Neo-vascularisation of musculocutaneous and muscle flaps after division of the major vascular supply: an experimental study. J Plast Reconstr Aesthet Surg 66:978–986

    Article  PubMed  Google Scholar 

  6. Souto JC, Almasy L, Borrell M, Blanco-Vaca F, Mateo J, Soria JM, Coll I, Felices R, Stone W, Fontcuberta J, Blangero J (2000) Genetic susceptibility to thrombosis and its relationship to physiological risk factors: the GAIT study. Genetic Analysis of Idiopathic Thrombophilia. Am J Hum Genet 67:1452–1459

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Warnecke IC, Kretschmer F, Brüner S, Frerichs O, Fansa H (2007) Hereditary thrombophilia in free microvascular flaps–a case report. Handchir Mikrochir Plast Chir 39:220–224

    Article  CAS  PubMed  Google Scholar 

  8. Kolbenschlag J, Daigeler A, Lauer S, Wittenberg G, Fischer S, Kapalschinski N, Lehnhardt M, Goertz O (2014) Can rotational thromboelastometry predict thrombotic complications in reconstructive microsurgery? Microsurgery 34:253–260

    Article  PubMed  Google Scholar 

  9. Srikanthan K, Viswanathan N, Yuen JC (2013) Free-flap failure in thrombophilia: case report and systematic review of the literature. Ann Plast Surg 71:675–681

    Article  CAS  PubMed  Google Scholar 

Download references

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.

Funding

There has been no funding for this work.

Conflict of interest

Hanno Pototschnig, Hans-Günther Machens, Daniel Müller and Yves Harder declare that they have no conflict of interest.

Patient consent

Patient provided written consent for the use of his images.

Ethical standards

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

Informed consent

Informed consent was obtained from the patient included in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yves Harder.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00238-015-1114-1

Keywords

Navigation