Asymptomatic Deep Vein Thrombosis during Free Flap: Concerns in Free Flap Surgery

Abstract

Background: Venous insufficiency is the most frequent cause of failure in free flap reconstruction of the lower extremity. When deep vein thrombosis is detected during preoperative assessment of the lower extremity, decisions regarding treatment plans become difficult, and no relevant guidelines regarding surgery and preoperative treatment of patients with deep vein thrombosis who need a free flap transfer are currently available. Methods: To find a relevant guideline in decision-making regarding surgery and preoperative treatment of patients with deep vein thrombosis who require free flap reconstruction, a systematic literature review was conducted searching MEDLINE, PubMed Central, Cochrane, and Embase databases for articles published between 1996 and 2015. In addition, the authors introduced six of their cases of deep vein thrombosis diagnosed before free flap surgery in which the flap survived. Results: The literature review identified two articles that discussed intraoperative deep vein thrombosis diagnosed in three patients, including the reported cases. Analyses included epidemiology, cause, and management strategy. A consensus for the management of asymptomatic deep vein thrombosis before free flap surgery is still lacking. In the authors' cases, successful flap transfer was possible by proceeding with an appropriate preoperative evaluation, intensive anticoagulation treatment, intraoperative reperfusion procedure, and postoperative care. Conclusion: Preoperatively detected asymptomatic deep vein thrombosis is not a contraindication for free flap reconstruction, and a flap transfer can be successfully performed with suitable planning and management. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.