Herpes Simplex Virus 1 Infection on a Reconstructive Free Flap

Objective: Herpes simplex virus 1 (HSV1) is a widespread virus that primarily causes orofacial infection. Methods: We present a case of HSV1 infection on a free radial forearm flap used to reconstruct a palate defect. Initially, the free flap appeared healthy; however, after 48 hours the free flap appeared in distress, with dark red colour and fast capillary refill. Venous congestion was suspected, and the patient underwent a second operation where no vascular compromise was found. Vesicles were noted on the free flap; swabs revealed HSV1 infection. Results: Complete recovery of the free flap was achieved with acyclovir. Discussion: To the best of our knowledge, this is the first report of HSV1 infection on a free flap that was found to be responsible for the free flap appearing distressed.