CASE REPORT Superior Gluteal Artery Perforator Flap Breast Reconstruction Salvage Following Late Venous Congestion After Discharge

Objective: Microvascular thrombosis is a dreaded complication of free tissue transfer, especially in breast reconstruction. Failure often leads to complete loss of the reconstruction and affects the patient both physically and psychologically. Fortunately, most vascular compromises occur early (within 24–36 hours) while the patient is still in the hospital and intervention takes place prior to irreversible thrombosis of the microvasculature. However, failures beyond 96 hours generally have dismal prognosis, especially because the patient is already home. Methods: A case of successful salvage is reported after an uncomplicated superior gluteal artery perforator flap performed for breast reconstruction returned from home with thrombosis of the venous pedicle the morning of postoperative day 5. Results: The pedicle was promptly explored and the venous patency reestablished using a combination of mechanical and chemical thrombolysis. At her 2-year follow-up, there was no evidence of fat necrosis and a satisfactory aesthetic outcome was achieved. Conclusion: Late salvage of failing free flap breast reconstruction from home is possible. Educating the patient on importance of self-examination is critical to salvage. The hospital system also needs to have the resources to handle such emergencies in order for rapid operative mobilization to expedite the patient's care.