CC BY 4.0 · Arch Plast Surg
DOI: 10.1055/a-2336-0262
Extremity/Lymphedema: Case Report

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

Abeje Brhanu Menjeta
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
,
Hyung Hwa Jeong
2   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
,
Tae Hyung Kim
2   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
,
Seongsu Jeong
2   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
,
Changsik John Pak
2   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
,
Hyunsuk Peter Suh
2   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
,
Joon Pio Hong
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
› Author Affiliations
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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.

Authors' Contributions

A.B.M conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted. H.H.J., T.H.K., S.J. gathered data for the manuscript as well as take part in the draft. T.H.K. gathered images and summarized tables. C.J.P., H.P.S. and J.P.H. conceptualized and designed the study, critically revised the manuscript, and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


Ethical Approval

This study was approved by the Institutional Review Board of Seoul Asan Medical Center (IRB No. 2024-0347).


Patient Consent

Patient consent forms were obtained for the use of photographs and information in the study.




Publication History

Received: 10 June 2023

Accepted: 28 May 2024

Accepted Manuscript online:
30 May 2024

Article published online:
06 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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