Late partial failure of a free ALT flap

Area of Science:

• Vascular Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Late microsurgical flap failure is uncommon, typically linked to vascular pedicle compression or infection.
• Peripheral vascular disease poses risks for reconstructive surgery outcomes.

Observation:

• A case of partial microsurgical flap failure occurred 3 weeks post-operatively.
• Vascular imaging revealed a previously unknown complete occlusion of the right external iliac artery.

Findings:

• Successful vascular bypass surgery restored blood flow to the compromised flap.
• The flap subsequently developed granulation tissue and was managed with a skin graft.

Implications:

• In patients with multiple peripheral vascular disease risk factors, proximal vessel occlusion must be considered as a cause of late flap failure.
• This case underscores the need for thorough pre-operative assessment and vigilance for uncommon vascular complications in reconstructive surgery.