Abstract
Salvage surgery for postoperative thrombosis that arose after head and neck free flap reconstruction was examined, and cases of arterial and venous thrombosis were compared.
There were 4 cases of arterial thrombosis and 5 cases of venous thrombosis. The venous thromboses were caused by pedicle kinking, twisting, or hematoma compression. All 5 cases were successfully salvaged by thrombectomy and re-anastomosis, resulting in a salvage rate of 100%. The arterial thromboses were caused by pedicle kinking or drainage tube compression in 2 cases ; however, the causes were unknown in the other 2 cases. In the cases with unknown causes, salvage surgery involving thrombectomy and re-anastomosis was performed twice, but these procedures eventually failed, resulting in total flap loss ( salvage rate : 50% ).
The successful salvage of a compromised flap requires the early detection and complete removal of any thrombi, and re-anastomosis to appropriate recipient vessels. In the cases of venous thrombosis, early detection was relatively easy, and the causes of the thrombosis were relatively straightforward and manageable ; thus, we were able to achieve an excellent salvage rate. In contrast, there were 2 cases of arterial thrombosis of unknown cause, and they could not be rescued despite repeated salvage attempts. In such cases, multiple take-backs might not be successful, and another flap transfer should be considered.
