Avulsion of vascular anastomosis in free-flap breast reconstruction

Vascular pedicle avulsion in free flap breast reconstruction: A case of diep flap salvage following early avulsion of venous anastomosis and literature review

“…16 Flap ischemia due to early thrombosis of the ruptured vessel(s) was another presenting sign. 5,12 However in our case, flap congestion due to early thrombosis of the partially avulsed venous anastomosis was the presenting sign.…”

“…In four cases both the artery and vein of the pedicle were avulsed, [13][14][15][16] while in three only the artery. 5,12,17 Interestingly our case represents the first and only report in the literature, in which only the vein of the pedicle was avulsed. Complete vessel avulsion was noticed in all except for two cases, one of partial arterial avulsion 5 and our case of partial vein avulsion.…”

“…Most of them were case reports, although some sporadic cases were identified in retrospective studies of breast reconstruction with the use of free flaps. 5,[12][13][14][15][16][17] Vascular pedicle avulsion was encountered in four different types of free flaps used for breast reconstruction. In four cases both the artery and vein of the pedicle were avulsed, [13][14][15][16] while in three only the artery.…”

“…13,15 In the other five cases, there was no clear avulsion mechanism. 5,12,14,16,17 Nevertheless, possible mechanisms seemed to be as follows: (1) inadvertent abrupt forceful movements of the patient resulting in the development of excessive traction forces on the vascular pedicle of the flap, (2) inadequate support of a heavy and pendulous flap exerting considerable traction on the pedicle, and (3) a combination of the aforementioned mechanisms. In our case, we suppose that neck hyperextension during vomiting strained the vein against the clavicle and resulted in partial avulsion of the anastomosis.…”

“…Nevertheless, other aetiologies resulting in disruption of vascular continuity, such as pedicle avulsion or anastomotic aneurysm rupture, although extremely rare, have been reported. 5,6 Vascular pedicle avulsion appears to be a very rare complication, although some cases might have been undiagnosed or not reported. Very few cases have been reported in the literature to date; not only in free flap breast reconstruction, but also in other fields of free flap transfer.…”