Management of venous thrombosis in fibular free osseomusculocutaneous flaps used for mandibular reconstruction: clinical techniques and treatment considerations.

Background Mandibular reconstruction by means of fibula transplants
is the standard therapy for severe bone loss after subtotal
mandibulectomy. Venous failure still represents the most common
complication in free flap surgery. We present the injection of
heparine into the arterial pedicle as modification of the revising
both anastomoses in these cases and illustrate the application with
a clinical case example. Methods Methods consist of immediate
revision surgery with clot removal, heparin perfusion by direct
injection in the arterial vessel of the pedicle, subsequent high
dose low-molecular weight heparin therapy, and leeches. After 6
hours postoperatively, images of early flap recovery show first
sings of recovery by fading livid skin color. Results The
application of this technique in a patient with venous thrombosis
resulted in the complete recovery of the flap 60 hours
postoperatively. Other cases achieved similar success without
additional lysis Therapy or revision of the arterial anastomosis.
Conclusion Rescue of fibular flaps is possible even in patients
with massive thrombosis if surgical revision is done quickly.