title: Microvascular free flap failure caused by unrecognized hypercoagulability.
abstract: BACKGROUND
  Microvascular free flap techniques have improved over the past two decades such that flap failure rates have dropped to under 3 percent in most large series of high-volume centers. However, despite technical and patient-selection advances, some components of free flap failure might be attributable to undiagnosed patient factors.
  
  
  METHODS
  In this clinicopathologic conference article, the authors present four patients with major free flap microvascular complications who were later diagnosed with multiple risk factors for hypercoagulability and biochemical abnormalities, and present the characteristic associated findings.
  
  
  RESULTS
  Previously undiagnosed hypercoagulability was present in four patients with major free flap microvascular complications. Hematologic consultation and laboratory investigation revealed the biochemical abnormalities.
  
  
  CONCLUSIONS
  In certain patients undergoing microvascular free flap reconstruction, undiagnosed hypercoagulability risk factors can be a source of free flap failure that is independent of patient selection or technical factors. Diagnosis, management, patient counseling, and initiation of deep venous thromboembolism prophylaxis measures are critical clinical components of care of these patients.
authors: Washington, D.C. From the Department of Plastic Surgery and the Division of Coagulation, Georgetown University Hospital.
authors: Steven P
authors: SP
authors: Davison
authors: Craig M
authors: CM
authors: Kessler
authors: Ali
authors: A
authors: Al-Attar
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology / Q000601:surgery; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000601:surgery; D005260:Female; D020022:Genetic Predisposition to Disease; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D008866:Microsurgery; D011183:Postoperative Complications / Q000453:epidemiology; D013524:Surgical Flaps / Q000009:adverse effects* / Q000098:blood supply*; D019851:Thrombophilia / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics; D017211:Treatment Failure