Page 48 - Read Online

Page 12 of 15 Inchauste. Plast Aesthet Res 2023;10:27 https://dx.doi.org/10.20517/2347-9264.2022.139

accomplished [16,66,68] . TPA is directly administered to the flap during flap salvage and has not demonstrated
an increased risk of hematoma to either the flap or abdomen [28,48] . Flap salvage rate with the use of
thrombolytics is lower, likely due to the increased thrombus burden that necessitated thrombolytic
[48]
therapy . When salvaging a failing flap with significant clot burden, this is typically the last maneuver that
can be done to void the flap of thrombus and reestablish perfusion.

CONCLUSION
Reconstructive autologous free flap breast reconstruction is a growing field with innovation, technological
advancements, broader application, and increased availability to patients. Core principles of microsurgery
such as meticulous dissection, atraumatic vessel handling, adequate magnification, appropriate recipient
vessel selection, and tension-free anastomosis with direct intima to intima contact are key maneuvers for a
successful microsurgical reconstruction. Identification and correction of inflow or outflow problems
intraoperatively can prevent thrombus formation and flap compromise. If vascular compromise is suspected
postoperatively, immediate return to the operating room for exploration is a must. Every microsurgeon
must develop an algorithm to first diagnose the problem, then implement a stepwise plan to execute the
maneuvers needed to reestablish perfusion to the flap in order to successfully salvage a failing flap.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
The author declared that there are no conflicts of interest.

Ethical approval and consent to participate
The University of Washington Medical Center stated that the study does not need to complete an IRB since
the figures are examples of surgical techniques similar to a case report. The author states that there is no
ethical concern since the photos do not include any PHI or patient identifiers such as a face or unique
tattoos.

Consent for publication
All patients gave consent for participation and publication.

Copyright
© The Author(s) 2023.

REFERENCES
1. McLean DH, Buncke HJ Jr. Autotransplant of omentum to a large scalp defect, with microsurgical revascularization. Plast Reconstr
Surg 1972;49:268-74. DOI PubMed
2. Holmström H. The free abdominoplasty flap and its use in breast reconstruction. An experimental study and clinical case report. Scand
J Plast Reconstr Surg 1979;13:423-27. DOI PubMed
3. Surgery. National plastic surgery statistics. Available from: https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-
surgery-statistics-full-report-2020.pdf. [Last accessed on 8 Jun 2023].