Operative complications and the management of intraoperative flow failure

Free flap flow failure can be either that of an artery and/or vein(s). One approach is to ascertain precisely which vessel(s) is compromised, then figure out whether the problem is on the patient's side or the flap side or at the anastomosis itself. A well perfused patient can minimize a patient-side problem. An anastomotic problem can be revised with or without adding a graft. There is potential to avoid further anastomotic problems with the use of some form of anticoagulant. Problems on the flap side, if limited, can be dealt with by resection or repair. Anticoagulants may be of value. Occasionally, another free flap is needed.