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Chen et al. Plast Aesthet Res 2023;10:24 Plastic and
DOI: 10.20517/2347-9264.2022.136
Aesthetic Research

Review Open Access

Diagnosis, management and prevention of
thrombotic complications in microsurgical breast

reconstruction: a review of the literature

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Amy Chen , Shannon R. Garvey , Asha Nanda, Bernard T. Lee, Ryan P. Cauley
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA 02215, USA.
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Authors contributed equally.
Correspondence to: Dr. Ryan P. Cauley, Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel
Deaconess Medical Center, Harvard Medical School, LMOB 5A, Boston, MA 02215, USA. E-mail: rcauley@bidmc.harvard.edu

How to cite this article: Chen A, Garvey SR, Nanda A, Lee BT, Cauley RP. Diagnosis, management and prevention of thrombotic
complications in microsurgical breast reconstruction: a review of the literature. Plast Aesthet Res 2023;10:24.
https://dx.doi.org/10.20517/2347-9264.2022.136

Received: 30 Nov 2022 First Decision: 18 Apr 2023 Revised: 30 Apr 2023 Accepted: 18 May 2023 Published: 29 May 2023
Academic Editor: Christine Hsu Rohde Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Autologous free tissue transfer is a safe and effective option for breast reconstruction. It is an increasingly utilized
technique with well-demonstrated improved patient satisfaction and quality of life. Microvascular thrombosis is a
rare but significant complication of microsurgical breast reconstruction, often resulting in flap failure. Proper
diagnosis and timely management of this complication are essential to free flap salvage. While microvascular
thrombosis poses a threat to flap survival, several methods may be employed to mitigate its more devastating
effects. Here, we present a comprehensive review of arterial and venous thrombotic complications in both the
intraoperative and postoperative settings. We discuss preoperative risk assessment, methods for flap monitoring,
and operative and medical management of thrombotic complications. We present an updated algorithm for the
intraoperative management of microvascular thrombosis adapted to reflect the most recent literature and our
novel algorithm for the postoperative management of microvascular thrombosis.

Keywords: Breast microsurgery, free flap monitoring, free flap thrombosis, free flap salvage

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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