Summary
Unusual or unexpected medical causes for free flap failure do occur but are uncommon.
We present a rare case of a fibula free flap failure due to an acute vasculitis which
was undiagnosed until after the flap had failed. In addition to two successful flap
salvages and intravenous heparin, an epoprostenol infusion was commenced but a third
salvage was not successful. The vasculitis resulted in marked blood vessel wall thickening,
and cutaneous manifestations which presented as late signs. High peri-nuclear anti
nuclear cytoplasmic antibody (pANCA) and myeloperoxidase (MOP) titres were subsequently
found and histology from several blood vessels showed marked inflammation throughout
the wall. A diagnosis of microscopic polyangiitis was made and high dose steroids
were subsequently commenced. Interestingly, he had vasculitis several years previously
treated with oral steroids but had been discharged from the rheumatology clinic. This
rare case illustrates the potential hazards of free flap surgery in the vasculitides
and discusses the warning signs and various management options to reduce the likelihood
of flap failure in these patients.
Keywords
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Article info
Publication history
Published online: April 26, 2012
Accepted:
March 27,
2012
Received:
January 6,
2012
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
