Prevention and treatment of thrombosis in microvascular surgery.

Microvascular free tissue transfer is associated with a 1 to 5% failure rate, most commonly as a result of thrombosis in the region of the vascular anastomosis or the distal flap microcirculation. Although many laboratory and clinical studies have been performed, there is no consensus on the efficacy and optimal dosage of various pharmacological agents available for the prevention and treatment of thrombosis in microvascular surgery. Some agents have potentially serious side effects; and all agents carry the risks of undesirable bleeding and hematoma formation. We review the current experimental and clinical evidence regarding the agents commonly used to prevent and treat thrombosis in microvascular surgery and make practical recommendations for the management of vascular compromise in free flaps.