Thrombosis and antithrombotic therapy in microvascular surgery

Thrombosis in microsurgery can either totally or partially reduce the perfusion to the free tissue transfer. Total occlusion normally occurs at or near the microvascular anastomosis, while microscopic vasospasm in the distal microcirculation can account for malperfusion and wound healing problems. The mechanisms of the anastomotic and microcirculatory responses to thrombosis are discussed. Drug therapy for each risk zone is identified, and a rationale for therapy is given.