title: Free Flap Survival Following Failure of the Vascular Pedicle.
abstract: BACKGROUND
  Controversy exists regarding whether or not, or, if so, how quickly free flaps can achieve neovascularization from the surrounding tissue bed and independence from the vascular pedicle. In this paper, we document the survival of free flaps despite early vascular pedicle thrombosis and review the literature regarding the period of time believed to be required for flap autonomy to occur.
  
  
  METHODS
  Case series
  
  
  METHODS
  Harbor-UCLA Medical Center
  
  
  METHODS
  We report 3 cases in which pedicle failures occurred within 2 weeks of free flap transfer. The first patient suffered repeated leaks from the vascular anastomosis with hematoma formation occurring on postoperative days 4, 6, and 17, ultimately requiring ligation of the pedicle. The second patient developed a salivary leak and accumulation of saliva around the pedicle, which was found thrombosed on postoperative day 11. The third patient lost Doppler signals from the pedicle on postoperative day 7 and 8, each occasion necessitating a return to the operating room for anastomotic revision. However, on postoperative day 9, the signal was lost yet again and no further revisions were attempted.
  
  
  RESULTS
  Two of the 3 flaps survived completely and the third was noted to have near complete survival.
  
  
  CONCLUSIONS
  Microvascular free flaps can survive despite complete pedicle failure as early as 10 days after surgery. The mechanism behind this may involve the process of neovascularization. We conclude that early free flap pedicle failure does not necessarily equate to complete flap loss.
authors: From the *Division of Plastic Surgery, and †Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
authors: Jay
authors: J
authors: Granzow
authors: Andrew I
authors: AI
authors: Li
authors: Amy
authors: A
authors: Caton
authors: J Brian
authors: JB
authors: Boyd
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D013927:Thrombosis / Q000209:etiology; D017211:Treatment Failure