Mechanical failure of a Fogarty catheter in a microsurgical procedure: a case report

How do i salvage that flap?; An evidence-based primer on salvage techniques for head & neck microvascular free flaps

Interventional strategies for dealing with microvascular free flap failure are varied among institutions and even individual surgeons. This systematic review aims to identify the published methods for salvaging a failing free flap and provide surgeons with a comprehensive toolset for successful intervention. A title and abstract search of the PubMed, Embase, and Web of Science databases was performed. 1694 abstracts were screened by three reviewers according to Prisma guidelines. 62 full text articles meeting inclusion criteria detailed techniques which were separated into the categories of thrombectomy, thrombolysis, leech therapy, vascular fistula, and an "other" category outlining techniques which did not fit into the prior framework. Assessment of the efficacy of individual salvage techniques is limited due to limited empirical data, however, the approach to successful salvage should be based on timely identification of flap compromise, followed by the implementation of one or several of the aforementioned techniques.

Direct thrombectomy as a salvage technique in free flap breast reconstruction

BACKGROUND

Breast reconstruction with microvascular free tissue transfer has become a widely used method. Despite a high rate of success, a compromised flap necessitating re-exploration can occur. Here, we introduce direct thrombectomy as a flap salvage technique, and compared the results with conventional thrombectomy.

METHODS

A total of 488 patients who underwent breast reconstruction using a free transverse rectus abdominis myocutaneous flap between March 2009 and February 2014 were retrospectively analyzed. Flap salvage was conducted by either conventional thrombectomy using a Fogarty catheter, or direct thrombectomy via either a side branch or additional incisions at the stump of the main pedicle at the distal end of the thrombus.

RESULTS

Flap compromise necessitating re-exploration due to extensive pedicle thrombosis was identified in 30 patients (6.1%). Direct thrombectomy was used in 9 patients, and conventional thrombectomy in 21 patients. Direct thrombectomy had a significantly higher success rate of flap salvage than conventional thrombectomy (88.9% vs. 47.6%; P = .049).

CONCLUSIONS

In the event of vascular thrombosis after free flap breast reconstruction, direct thrombectomy at the proximal pedicle stump beside the anastomosis opening appears to be an effective and reliable option that minimizes vessel trauma related to conventional catheter use. © 2016 Wiley Periodicals, Inc. Microsurgery 37:402-405, 2017.