Prevention of Microsurgical Thrombosis

Free tissue transfer is a safe and reliable mode of tissue reconstruction. Though it is the highest rung on the reconstructive ladder, this method of reconstruction is utilized by a multitude of surgical specialties including: plastic and reconstructive, orthopaedic, otolaryngology, and oral maxillofacial. There are multiple indications for free tissue transfer. A few examples are: skeletal defects after debridement for osteomyelitis, breast reconstruction, various trunk and extremity defects, and most recently composite tissue allotransplantation – primarily face and hand transplantion. Despite employing perfect microsurgical technique, flap failure caused by anastomotic thrombosis continues to occurs in complicated and uncomplicated microvascular anastomosis. Many pharmacologic agents have been studied experimentally and clinically both in the treatment and prophylaxis of microvascular thrombosis; however, there still remains no consensus as to what the optimal pharmacologic regimen should be. In this chapter, we discuss the reported incidence of flap failure caused by microvascular thrombosis, review the pathophysiology of thrombus formation, review the anti-thrombotic pharmacologic agents commonly used for prophylaxis, and overview the current methods of flap monitoring.