Guidelines for Complications of Cancer Treatment Vol VIII Part B

1) Recipient site problems- The majority of recipient site complications are relatedto vascular thrombosis. The incidence of vascularthrombosis requiring urgent re exploration is about sixpercent.- Venous thrombosis far outnumbers the arterialthrombosis.- Majority of vascular thrombosis occurs within 3 days ofsurgery.- Late thrombosis mainly results from local infection,subsequent fistula formation or mechanical compression.- There is no difference in the rates of exploration or flapfailure as a function sex or age.- Potential for thrombosis exists in all microvascularanastomosis.- The use of drugs to prevent thrombosis is heavily debatedand not universally agreed.- There is no level I evidence of utility of these drugs orsuperiority of one drug over another as prophylaxis inprevention of thrombosis.- At our centre, we do not use any thromboprophylactiveagents because of their potential side effects andunproven benefit.2) Monitoring Flap Viability- Clinical monitoring of flap by response to prick byhypodermic needle is most common and reliable.- Normal color, temperature, absence of congestion oredema and slow bright red blood on needle prick is thesign of adequate perfusion of flap.- A flap with venous congestion is edematous, bluish, coldand on needle prick shows brisk and profuse flow ofdark blood.185