Venous Thrombosis in Free Flap Reconstruction Following Intravenous Administration of Furosemide: A Case Report

Jung,  Su Young; Jeong,  Seong Ho; Dhong,  Eun Sang; Han,  Seung Kyu; Kim,  Woo Kyung

doi:2017.22.4.288

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Case Report

Archives of Hand and Microsurgery 2017;22(4):288-292.
Published online December 1, 2017.
DOI: https://doi.org/10.12790/ahm.2017.22.4.288

Venous Thrombosis in Free Flap Reconstruction Following Intravenous Administration of Furosemide: A Case Report

Su-Young Jung, Seong-Ho Jeong, Eun-Sang Dhong, Seung-Kyu Han, Woo-Kyung Kim

Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Seoul, Korea. surgilearn@korea.ac.kr

Received: 12 October 2017 • Revised: 16 October 2017 • Accepted: 17 October 2017

Abstract

Some patients who undergo free flap reconstruction may suffer pulmonary edema, requiring postoperative medical intervention including use of diuretic agents, such as furosemide. However, the effect of diuretic agents on a free flap remains unclear. We present a case of flap loss due to venous thrombosis following intravenous infusion of furosemide in a 36-year-old patient. The patient suffered from severe dyspnea and acute pulmonary edema caused by fluid overload during the perioperative period. Furosemide was administered intravenously for relieving dyspnea. After 4 hours, the flap showed signs of venous congestion. Surgical exploration revealed a venous thrombosis of the vascular pedicle with complete luminal occlusion. We would like to suggest that use of furosemide in patients underwent reconstruction with free flaps must be limited only to cases with evidence of acute respiratory failure. Even in these cases, intensive flap monitoring and preparation for early intervention on venous thrombosis will be required.

Key Words: Venous thrombosis, Free flaps, Furosemide

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