Abstract
Failure 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.
Keywords
hyperhomocysteinemia - free flap failure - hypercoagulability
