Free Flap Failure Associated with Heparin-Induced Thrombocytopenia: Is It Preventable?

Heparin-induced thrombocytopenia (HIT) is a serious adverse effect of unfractionated heparin, particularly in the setting of microsurgery, with a reported salvage rate of <25% of free flaps. HIT presenting as venous thromboembolisms (VTEs) can be a more challenging problem to the reconstructive surgeon. The hematology literature reports a prevalence of HIT as high as 12% among patients presenting with VTEs. Complications associated with HIT are preventable if a high index of suspicion is maintained and proper treatment is implemented. A 68-year-old man with VTEs who failed a parascapular fasciocutaneous flap to the forearm secondary to undiagnosed HIT is reported. The authors propose an algorithm to approach such a dilemma and implement adequate treatment measures before commencing any microsurgical procedures in patients to minimize any untoward consequences.