Higher Education | Medicine and Health Sciences | Plastic Surgery
Arterial thrombosis is a rare, but dreadful complication in microvascular surgery. Here we report on a case of recurrent arterial thrombosis in a latissimus dorsi (LD) free flap used for scalp reconstruction in an 18-year-old woman who sustained a gunshot wound (GSW) to the head. In the immediate postoperative period, internal and external doppler signals to the flap were lost. Emergent surgical exploration revealed arterial thrombosis, which was emergently explored and successfully repaired. Doppler signals were again lost and the flap was emergently explored for a second time. Following revision of the arterial anastomosis, flap perfusion decreased and appeared to correlate with the patient’s blood pressure. After administration of vasopressors to increase the Mean Arterial Pressure (MAP) to a goal of 70 or greater, flap perfusion and doppler signals were consistent. Here we describe a case of successful free flap salvage using both intraoperative and postoperative vasopressors for recurrent arterial thrombosis. Furthermore, vasopressor administration may be beneficial in select patients to maintain adequate flap perfusion in those who demonstrate intraoperative hypotension and no other identifiable causes of flap compromise, as in the present case.
Microsurgery, Free flap salvage, vasopressors, latissimus dorsi free flap, arterial thrombosis
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Ford, A., Palacios Vazquez, H., , Figy, S. Successful Latissimus Dorsi Free Flap Salvage using Intraoperative Vasopressors: A Case Report. Graduate Medical Education Research Journal. 2023 Jun 30; 5(1).