Successful Flap Revascularization Following Late Pedicle Avulsion

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

“…The mechanism of the injury was evident in two cases of iatrogenic aetiology that happened intraoperatively, and was the result of high levels of strain exerted by the surgeon to the vascular pedicle. 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.…”

“…17 Vascular pedicle avulsion occurred with the use of three different recipients: the circumflex scapular, 5 the thoracodorsal, 12 and the internal mammary vessels. [13][14][15][16][17] In the majority of cases, five including our case, the internal mammary vessels were used. However, the small number of cases prevents us from making any conclusive statement relating the internal mammary vessels with higher avulsion rates.…”

“…Although extremely rare, disruption of the vascular pedicle can lead not only to flap failure but may also threaten the patient's life, as a result of massive bleeding. 12,13 A MEDLINE search of papers referring to free flap vascular pedicle avulsion was followed by an extensive manual search on the same topic, using references from relevant published papers. A total of nine cases were found, seven of which occurred in free flap breast reconstructions, and are listed in detail in Table 1.…”

“…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.…”

“…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. 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.…”