I am not surprised by the experience of Dr. Spanio di Spilimbergo and colleagues with a failed free flap. It has been my contention from day one that the majority of microsurgical failures are caused primarily by technical errors in either donor or recipient vessel regions. Most commonly, patient disease and other comorbidities are blamed. However, when the flawless technical execution of a case is followed by overt failure and thrombosis of all vessels, one must start looking for a cause. In this case, they found one. Cardiologists are very much aware of this problem, which is a common cause of coronary and cerebrovascular thrombosis. It is hoped that microsurgeons will become more cognizant.
Joe Upton, M.D.
830 Boylston Avenue, Suite 212
Chestnut Hill, Mass. 02467
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