Delayed free flap salvage after venous thrombosis.

The incidence of free flap failure is reported at 4% to 5%,but pedicle thrombosis occurs in a higher percentage, with the difference resulting from successful salvage of failing flaps. Often, these failures are attributed to postoperative venous thrombosis with salvage reported at 42%. The venous engorgement of the flap and the resulting microvascular changes lead to a more rapid and less reversible no-reflow phenomenon established within 6 hours. However, this report shows successful free flap salvage with thrombolytic drugs after 6 hours, highlighting that the mechanisms of free flap failure are still poorly understood.

Ischemic optic neuropathy and implications for plastic surgeons: report of a new case and review of the literature.

BACKGROUND: Postoperative visual loss is a rare and devastating complication after nonocular as well as ocular surgery. A case of such a complication arising as a consequence of nonocular surgery prompted a review of the literature, and an appraisal of current theories on etiology, risk factors, and potential treatment options, as well as implications for informed consent. It is clear from our review that all patients undergoing both reconstructive and cosmetic surgery are at risk. METHODS: A literature review was performed to identify all cases of ischemic optic neuropathy (both anterior and posterior subtypes) subsequent to any type of plastic, reconstructive, and aesthetic surgery procedures. An analysis of current knowledge regarding risk factors, etiology, prevention, and treatment options was undertaken. RESULTS: A total of 38 patients aged between 16 and 76 years affected by ischemic optic neuropathy were identified, many as a consequence of routine and sometimes minor operative procedures. CONCLUSIONS: Ischemic optic neuropathy can be a devastating complication of surgery. Plastic surgeons need to be aware of the risks, as well as the signs and symptoms, and counsel at-risk patients accordingly because of the potentially devastating nature of this complication. There are significant implications in relation to informed consent, underscored by the legal case of Rogers v Whitaker, 67 ALJR 47 (Aust 1992), which highlights the importance within the consent process of complications threatening sight, no matter how small.

Anterolateral thigh flap as the ideal flap to full-thickness cheek reconstruction.

Reconstruction of the cheek presents a number of challenges when seeking to recreate form and function. The use of the anterolateral thigh flap in various and novel configurations is argued as being the ideal reconstruction, illustrated by case reports.