Postoperative thrombosis represents a potentially devastating complication of microvascular free-tissue transfer and is the most common cause of flap failure. We performed a retrospective review of 267 free flap transfers that were performed our institution from 2000 to 2014. During the study period, pedicle thrombosis was detected in 19 of the 22 free flaps that were re-explored emergently. The majority of re-exploration procedures were carried out within the first 48 hours, except in one case. Of these 19 flaps, 10 flaps were salvaged completely, and partial and total flap loss was seen in 5 and 4 flaps, respectively ( flap survival rate, 78.9 % ). In all 4 of the cases in which total flap loss occurred, the flaps were used to reconstruct head and neck lesions.
Careful monitoring and urgent re-exploration are critical for salvaging compromised flaps. We demonstrate a technique in which small side holes are made in the vascular pedicle and the target thrombus is removed with dilator forceps. We consider that this technique is useful for achieving complete mechanical thrombus removal.