Conservative Management of Presumptive Free Flap Pedicle Compromise on Postoperative Day 6: Report of Two Cases and Literature Review.
Filippo A G Perozzo, Diwakar Phuyal, Julia Ting et al.
✦ AI-curated · Sources linked
Case in brief
Two patients underwent lower-extremity free-flap reconstruction for exposed tibial bone or hardware. On postoperative day 6, both developed loss of Doppler signal and clinical ischemia, raising concern for late pedicle compromise. Bedside indocyanine green imaging showed peripheral perfusion arising from flap margins distant from the anastomosis, consistent with early neovascularization. Re-exploration was deferred; both flaps survived, with minor marginal epidermal loss but no full-thickness necrosis. Complete healing occurred within 6 weeks, and both patients had 6-month follow-up.
What made this case unusual
Despite clinical ischemia and absent Doppler signals, imaging showed perfusion entering from flap margins distant from the anastomosis, supporting conservative management of presumptive late pedicle compromise.
Diagnostic / clinical pearl
In these cases, bedside indocyanine green imaging helped identify peripheral flap perfusion despite absent Doppler signals; such findings may inform selected decisions, but do not establish conservative management as standard care.
Why it matters
The true failure rate of conservative management cannot be estimated because the literature review is subject to publication bias; prospective validation is needed before definitive recommendations.