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

Background: Venous insufficiency is the most frequent cause of failure in free flap reconstruction of the lower extremity. When deep vein thrombosis (DVT) 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 DVT who need a free flap transfer are currently available. Methods: In order to find a relevant guideline in decision-making regarding surgery and preoperative treatment of patients with DVT 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, we introduced six of our cases of DVT diagnosed before free flap operation in which the flap survived. Results: The literature review identified two articles that discussed intra-operative DVT diagnosed in three patients, including the reported cases. Analyses included epidemiology, etiology, and management strategy. A consensus for the management of asymptomatic DVT before free flap is still lacking. In our 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 DVT is not a contraindication for free flap reconstruction, and a flap transfer can be successfully performed with suitable planning and management. Acknowledgement: None Financial Disclosure: The author(s) declare no potential conflicts of interest with respect to the research, authorship, and / or publication of this article. Funding: The work was supported by the Ewha Womans University Research Grant of 2015. Corresponding author: Bo Young Park, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, School of Medicine, Ewha Womans University, Seoul, Korea, Mok 5-dong, Yangcheon-Gu, Seoul, S. Korea, 158-710, Tel.: 82-2-2650-5149/ Fax: 82-2-3410-0036/ E-mail: byps@icloud.com ©2018American Society of Plastic Surgeons