Related Experiment Video
Updated: Jun 27, 2026

Measurement of Factor V Activity in Human Plasma Using a Microplate Coagulation Assay
Published on: September 9, 2012
Factor V Leiden mutation and thrombotic occlusion of microsurgical anastomosis after free TRAM flap
A E Handschin1, M Guggenheim, M Calcagni
1Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospital of Zurich, Rämistrasse 100, Zurich, Switzerland.
Abstract:
The transverse rectus abdominis muscle flap is widely used in free microvascular tissue transfer for breast reconstruction following mastectomy. Flap survival may be compromised by failure at the microsurgical anastomosis due to both venous and arterial thrombosis. It is unclear, whether hereditary thrombophilia represents a risk factor for early thrombotic occlusion following free flap procedures. We present a case of a patient with previously diagnosed activated protein C resistance caused by heterozygous factor V (position 1691 G-->A) Leiden mutation in whom a free transverse rectus abdominis muscle flap was performed. The postoperative course was complicated by repeated thrombosis of both the venous and arterial part of the anastomosis. Immediate thrombectomy and repeated arteriography allowed for partial flap salvage. More data are needed to analyze the impact of hereditary thrombophilia on microvascular anastomosis failure.
Related Concept Videos
Venous Thrombosis III: Interprofessional Care
Venous Thrombosis I: Introduction
Anticoagulant Drugs: Low-Molecular-Weight Heparins
Clot Retraction and Fibrinolysis
Extrinsic and Intrinsic Pathways of Hemostasis
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which forms a...
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies