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Related Experiment Video

Updated: May 26, 2026

A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

Published on: January 15, 2017

Why haematomas cause flap failure: an evidence-based paradigm.

Graeme E Glass¹, Jagdeep Nanchahal

¹Imperial College, London, UK. g.glass@imperial.ac.uk

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS

|January 10, 2012

Summary

Subjacent hematomas cause flap compromise through complex biochemical pathways, leading to tissue ischemia. Prompt hematoma evacuation is crucial for flap survival, regardless of tension.

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Last Updated: May 26, 2026

A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

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Published on: January 15, 2017

An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps

An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps

Published on: December 5, 2025

Area of Science:

Biomedical Engineering
Tissue Engineering
Plastic Surgery

Background:

Hematomas compromise tissue flaps via mechanisms beyond simple pressure or thrombosis.
Previous animal studies indicated whole blood toxicity to random pattern flaps, but detailed mechanisms were unclear.

Purpose of the Study:

To elucidate the biochemical and cellular mechanisms by which subjacent hematomas lead to flap compromise.
To inform clinical practice regarding hematoma management in flap surgery.

Main Methods:

A comprehensive literature review of peer-reviewed publications on hematoma and tissue compromise.
Inclusion of studies on free tissue transfers, vascularized flap models, and brain injury.
Clinical correlation with free vascularized flaps and rhytidectomy skin flaps.

Main Results:

Hematomas account for 2-4% of free tissue transfer and local flap compromise.
Key mechanisms include platelet degradation releasing cytokines, neutrophil recruitment, reactive oxygen species (ROS) production, and complement cascade activation.
Endothelial cell disruption, pro-thrombotic activation, and small vessel occlusion result in tissue ischemia and further ROS generation.

Conclusions:

Hematoma-induced tissue injury involves a complex interplay of biochemical and cellular processes converging on local tissue ischemia.
Emergent evacuation of hematomas should be strongly considered to prevent flap compromise, independent of perceived envelope tension.