Management of venous thrombosis in fibular free osseomusculocutaneous flaps used for mandibular reconstruction: clinical techniques and treatment considerations.
BACKGROUND
Mandibular reconstruction by means of fibula transplants is the standard therapy for severe bone loss after subtotal mandibulectomy. Venous failure still represents the most common complication in free flap surgery. We present the injection of heparine into the arterial pedicle as modification of the revising both anastomoses in these cases and illustrate the application with a clinical case example.


METHODS
Methods consist of immediate revision surgery with clot removal, heparin perfusion by direct injection in the arterial vessel of the pedicle, subsequent high dose low-molecular weight heparin therapy, and leeches. After 6 hours postoperatively, images of early flap recovery show first sings of recovery by fading livid skin color.


RESULTS
The application of this technique in a patient with venous thrombosis resulted in the complete recovery of the flap 60 hours postoperatively. Other cases achieved similar success without additional lysis Therapy or revision of the arterial anastomosis.


CONCLUSIONS
Rescue of fibular flaps is possible even in patients with massive thrombosis if surgical revision is done quickly.
Clinic for Maxillofacial Surgery, University of Mainz, Augustusplatz 2, 55131 Mainz, Germany. draenert@yahoo.com
Florian G
FG
Draenert
Martin
M
Gosau
Bilal
B
Al Nawas
D000925:Anticoagulants / Q000627:therapeutic use; D016025:Bone Transplantation; D005360:Fibula / Q000637:transplantation*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D019651:Plastic Surgery Procedures; D012086:Reoperation; D013524:Surgical Flaps / Q000009:adverse effects* / Q000098:blood supply; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology* / Q000628:therapy*
D000925:Anticoagulants; D006493:Heparin