Free flap survival despite early loss of the vascular pedicle

Background. Early success of microvascular free tissue transfer is dependent upon the patency of the primary vascular pedicle. In time, neovascularization from the recipient bed and surrounding wound margins into the graft may be sufficient to maintain flap viability. The time necessary for successful neovascularization to occur is unclear. Most believe that prior radiation therapy will delay this process. Methods. This case report describes a patient, status postchemoradiotherapy, who underwent composite resection with anterolateral thigh free flap reconstruction for a new base of tongue squamous cell carcinoma. On postoperative day 9 the vascular pedicle thrombosed secondary to abscess formation. Results. Despite early loss of the arterial and venous pedicle, the flap survived completely. Conclusion. After microvascular free tissue transfer, neovascularization sufficient to maintain flap viability independent of the primary vascular pedicle may occur by postoperative day 9. This early revascularization can also occur despite a history of radiotherapy.