Clinical Significance of Hyperhomocysteinemia in Free Flap Failure: A Case Report

Author:

Menjeta Abeje Brhanu1,Jeong Hyung Hwa2,Kim Tae Hyung2,Jeong Seongsu2,Pak Changsik John2,Suh Hyunsuk Peter2,Hong Joon Pio1

Affiliation:

1. Division of Plastic and Reconstructive Surgery, Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia

2. Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Abstract

AbstractFailure of a microvascular free flap remains rare, yet multiple failures can occur, particularly in the presence of hypercoagulable conditions. This case series highlights our experience with a rare hypercoagulable state: hyperhomocysteinemia.We present two cases of patients with hyperhomocysteinemia in this report. High-dose heparinization was administered to both patients, resulting in successful salvage of one flap and failure of the other. Notably, one patient had a history of prior free flap failures. However, after correcting hyperhomocysteinemia, subsequent free flaps were successful.In cases of detected complications, a coagulability study is warranted, and adjustments to anticoagulation treatment may be necessary. Furthermore, when a history of flap failures is evident, screening for hyperhomocysteinemia may be warranted, with correction made prior to reconstruction.

Publisher

Georg Thieme Verlag KG

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