Clot Removal from Distal Part in Microvascular Radial Forearm Free Flap: Technical Note

Microvascular reconstruction has high success rates, but up to 10% of patients experience vascular compromise, most commonly due to venous congestion or arterial thrombosis. Traditional flap salvage includes mechanical milking of the pedicle and heparinized irrigation; however, when these measures fail to restore perfusion, alternative strategies are required. In this technical note, we present a Fogarty catheter-based technique for thrombus removal, particularly in radial forearm free flaps where the distal artery is accessible. The catheter is introduced distally to extract the clot without reopening the anastomosis, allowing immediate confirmation of reperfusion. This technique is simple, time-efficient, and effective for managing arterial thrombosis in free flap surgery.