Abstract
Background: Intraoperative thrombosis during microvascular surgery is a nasty complication. Most intraoperative thromboses occur at the proximity of the anastomosis and microsurgical salvage techniques are needed to correct the complication. The aim of this article is to provide an overview of basic clinical patency testing and microsurgical salvage techniques. Methods: A search of the literature up to November 2020 was performed, using PubMed and Web of Science databases. Articles reporting on clinical intraoperative patency testing and/or salvage techniques in microvascular surgery were included. Results: Comprehensive illustrations of intraoperative clinical patency testing include: pulsation pattern, flicker test and milking test. The following surgical salvage techniques for both end-to-end and end-to-side intraoperative microvascular occlusion management are described: suture-line thrombectomy, thrombectomy through arteriotomy, anastomotic resection with complete re-anastomosis and, balloon extraction. Conclusion: Decision making in surgical salvage techniques for microvascular thrombosis depends on localization of the thrombus and the surgeon’s experience and preference. In case of any doubt, it is better to reopen a few sutures and have a clear inspection of the anastomosis in order to prevent redo surgeries. This paper serves as a guide for especially the starting microsurgeon to clinically and surgically identify and handle an intraoperative microvascular anastomosis thrombosis and occlusion.
Highlights
Intraoperative thrombosis during microvascular surgery is a nasty complication
Most intraoperative thromboses occur at the proximity of the anastomosis and microsurgical salvage techniques are needed to correct the complication
This paper serves as a guide for especially the starting microsurgeon to clinically and surgically identify and handle an intraoperative microvascular anastomosis thrombosis and occlusion
Summary
Intraoperative thrombosis during microvascular surgery is a nasty complication. Failure rate in free flap surgery is reported between 2% and 15% mostly due to thrombosis [1] [2] [3] [4] [5]. The clinical and surgical techniques, for both patency testing and salvaging, are the focus of this article. When an intraoperative thrombosis occurs, the clot is usually located at the anastomosis, and surgical salvage techniques are needed to manage the occlusion [3]. The aim of this article is to provide an overview of basic clinical patency testing and microsurgical salvage techniques for both end-to-end and end-to-side anastomosis. The aim of this article is to provide an overview of basic clinical patency testing and microsurgical salvage techniques. Articles reporting on clinical intraoperative patency testing and/or salvage techniques in microvascular surgery were included. The following surgical salvage techniques for both end-to-end and end-to-side intraoperative microvascular occlusion management are described: suture-line thrombectomy, thrombectomy through arteriotomy, anastomotic resection with complete re-anastomosis and, balloon extraction. This paper serves as a guide for especially the starting microsurgeon to clinically and surgically identify and handle an intraoperative microvascular anastomosis thrombosis and occlusion
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