Microvascular anastomotic aneurysms in the clinical setting: case report and review of the literature.

Microvascular anastomotic aneurysms are an uncommon complication in reconstructive surgery, which can lead to free flap failure or even threaten the life of the patient. The literature referring to microvascular anastomotic aneurysms was reviewed in order to highlight their clinical presentation, diagnostic work-up, and therapeutic management. Also, a case of a ruptured aneurysm following free transfer of a fibula flap to the lower face is presented. No prospective studies were found. Only few case reports and some sporadic cases in retrospective studies referring to free flap complications were identified. All the aneurysms were false, the main etiologic factor was assumed to be infection, and the presenting signs were either arterial bleeding, as a result of rupture, or the presence of a pulsating mass. No widely accepted therapeutic guidelines were found, and the treatment was tailored to the specific clinical presentation of each case. Regarding the reported case, excision of the ruptured aneurysm and restoration of vascular continuity with a vein graft ensured complete survival of the flap. In conclusion, microvascular anastomotic aneurysms, although uncommon, represent a complication that every reconstructive surgeon should be aware of. Early diagnosis and proper treatment are crucial for a successful outcome. Selection of the appropriate treatment should be based on the presenting sign, the location, the degree of flap neovascularization as well as the condition and quality of the recipient bed; and comprises either ligation of the nutrient artery or excision of the aneurysm and restoration of arterial continuity. (c) 2009 Wiley-Liss, Inc.