Arch Hand Microsurg.  2024 Jun;29(2):127-131. 10.12790/ahm.24.0005.

Improved flap perfusion and hemostasis after postoperative embolization in free flap surgery: a case report

• Kim J
• Kwon H
• Kim S
• Song SH
• Oh SH
• Ha Y

• KMID: 2556364
• DOI: http://doi.org/10.12790/ahm.24.0005

Abstract

This study aims to present a novel use of coil embolization in managing postoperative bleeding after free flap surgery, a technique typically reserved for other medical complications. We report the case of a 77-year-old female patient who underwent muscle-sparing latissimus dorsi free flap surgery for recurrent myxofibrosarcoma on her left thigh. Although hemostasis was achieved hemostasis during surgery, the patient experienced postoperative bleeding, which was initially managed with compression and blood transfusions. Upon a critical drop in the hemoglobin level, coil embolization was performed at the proximal segment of the descending branch of the lateral circumflex femoral artery. Coil embolization successfully controlled bleeding, while preserving blood flow to the flap. The patient’s hemoglobin levels stabilized, and the flap’s perfusion improved post-procedure. This approach proved effective in managing bleeding in areas other than the anastomosis site, with the patient showing a satisfactory recovery and no significant complications in the 30-day postoperative period. Coil embolization, a method commonly used for gastrointestinal bleeding and other vascular issues, can be a viable and effective option for controlling postoperative bleeding after free flap surgery. This case demonstrates its potential as a lifesaving intervention while preserving flap viability. However, further research with more cases is needed to evaluate the generalizability and long-term outcomes of this technique in similar surgical contexts.

Keyword

Perforator flap; Neoplasms; Plastic surgery procedures

Figure

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  Fig. 1. Post-embolization angiography and computed tomography angiography. (A) The image displays a bleeding point indicated by the arrow, alongside the pedicle that points toward the flap anastomosis, marked by a asterisk. (B) It features a computed tomography angiography image, which clearly demonstrates the patency of the vessel leading to the flap anastomosis, as denoted by a asterisk, even after embolization. The arrow indicates the site where the bleeding point was occluded using a coil.

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  Fig. 2. Schematic illustration depicting the vascular anatomy relevant to the case, with the femoral artery leading to the lateral circumflex femoral artery. The site of coil embolization is shown proximal to the bleeding point, which is depicted in relation to the anastomosis site of the flap.

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  Fig. 3. Gross photographic documentation of surgical and postoperative progress (A) Extensive defect following excision. (B) Muscle-sparing latissimus dorsi flap measuring 20×15 cm harvested. (C) Immediate postoperative appearance. (D) The flap prior to embolization, noted for its pale color. (E) The flap after embolization, with noticeable color improvement. (F) Appearance of the reconstructed site at 30 days after operation.

Reference

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