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Free-Flap Failure in Thrombophilia: Case Report and Systematic Review of the Literature

Srikanthan, Krithika MD; Viswanathan, Nisha MD; Yuen, James C. MD

doi: 10.1097/SAP.0b013e3182586b47
Review Article

Abstract: Free-tissue transfer has become routine surgery because of standardization of instrumentation, techniques, and training. The incidence of microvascular thrombosis leading to free-flap failure is relatively low; however, anastomotic thrombosis can still occur despite the best of circumstances. Although majority of the time it is due to technical mishap or misjudgment, free-flap failure can occur due to intrinsic factors, such as the patient’s increased propensity to develop clots. We describe a case report of a patient with malignancy and multiple thrombophilias, which led to 2 successive failures in microvascular flap transfer to restore abdominal domain. The aim o f this article is to increase awareness of the potential for thrombophilias to cause a dismal outcome in free-tissue transfer. A review of the literature will be presented, and published cases of free-flap failure in patients with thrombophilia(s) will be summarized.

From the Division of Plastic Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.

Received September 2, 2011, and accepted for publication, after revision, April 2, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: James C. Yuen, MD, Division of Plastic Surgery, Department of Surgery, University of Arkansas for Medical Sciences, 4301 W Markham, Slot 720, Little Rock, AR 72205. E-mail: ksrikanthan@uams.edu; srikanthan.krithika@gmail.com.

© 2013 by Lippincott Williams & Wilkins