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

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

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

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