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

Clinical significance of Hyperhomocysteinemia in Free Flap Failure- A Case Report

ABEJE BRHANU MENJETA
1   Plastic Surgery, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (Ringgold ID: RIN443880)
2   Plastic Surgery, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (Ringgold ID: RIN443880)
,
Tae Hyung Kim
3   Department of Plastic and Reconstructive Surgery, Asan Medical Center, Seoul, Korea (the Republic of) (Ringgold ID: RIN65526)
,
HyungWha Jeong
4   Plastic and reconstructive surgery, Asan Medical Center, Songpa-gu, Korea (the Republic of) (Ringgold ID: RIN65526)
,
Seongsu Jeong
5   Plastic and Reconstructive Surgery, Asan Medical Center, Seoul, Korea (the Republic of)
,
Changsik John Pak
6   Plastic Surgery, University of Ulsan, Ulsan, Korea (the Republic of) (Ringgold ID: RIN35029)
,
Hyunsuk Peter Suh
7   Plastic surgery, University of Ulsan, Seoul, Korea (the Republic of) (Ringgold ID: RIN35029)
,
Jp Hong
8   Plastic Surgery, University of Ulsan, Seoul, Korea (the Republic of) (Ringgold ID: RIN35029)
› Author Affiliations

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.



Publication History

Received: 10 June 2023

Accepted after revision: 28 May 2024

Accepted Manuscript online:
30 May 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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