Arch Hand Microsurg.  2017 Dec;22(4):288-292. 10.12790/ahm.2017.22.4.288.

Venous Thrombosis in Free Flap Reconstruction Following Intravenous Administration of Furosemide: A Case Report

• Jung SY
• Jeong SH
• Dhong ES
• Han SK
• Kim WK

• KMID: 2406134
• DOI: http://doi.org/10.12790/ahm.2017.22.4.288

Abstract

Some patients who undergo free flap reconstruction may suffer pulmonary edema, requiring postoperative medical intervention including use of diuretic agents, such as furosemide. However, the effect of diuretic agents on a free flap remains unclear. We present a case of flap loss due to venous thrombosis following intravenous infusion of furosemide in a 36-year-old patient. The patient suffered from severe dyspnea and acute pulmonary edema caused by fluid overload during the perioperative period. Furosemide was administered intravenously for relieving dyspnea. After 4 hours, the flap showed signs of venous congestion. Surgical exploration revealed a venous thrombosis of the vascular pedicle with complete luminal occlusion. We would like to suggest that use of furosemide in patients underwent reconstruction with free flaps must be limited only to cases with evidence of acute respiratory failure. Even in these cases, intensive flap monitoring and preparation for early intervention on venous thrombosis will be required.

Keyword

Venous thrombosis; Free flaps; Furosemide

MeSH Terms

Administration, Intravenous*
Adult
Dyspnea
Early Intervention (Education)
Free Tissue Flaps*
Furosemide*
Humans
Hyperemia
Infusions, Intravenous
Perioperative Period
Phenobarbital
Pulmonary Edema
Respiratory Insufficiency
Venous Thrombosis*
Furosemide
Phenobarbital

Figure

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  Fig. 1. Clinical photography taken at 4 hours postoperation. Suspicious venous flap congestion observed.

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  Fig. 2. The chest radiographs showed acute pulmonary edema. (A) Preoperative, (B) postoperative day 4.

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  Fig. 3. Color change of the flap after 4 hours (A), 6 hours (B), and 12 hours (C) following furosemide administration.

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  Fig. 4. (A) Sign of venous thrombosis on the flap. (B) Portion of venous anastomosis with intraluminal thrombus.

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