ePlasty: Vol. 18
Salvage of Free Flaps Following Vascular Pedicle Avulsion Using “Supermicrosurgery” Techniques: A Case Report of DIEP Free Flap Salvage and Review of the Literature
Nicholas Cereceda-Monteoliva, MBBS, BSc, David Izadi, MB BChir, MA(Oxon), MA(Cantab), MRCS, and Sherif Wilson, MB ChB, FRCS, FRCS (Plast)

Department of Plastic Surgery, Royal Devon & Exeter Hospital, Exeter, United Kingdom

Correspondence: nicholas.cm@nhs.net
Keywords: pedicle injury, avulsion, free flap, supermicrosurgery, salvage


A 46-year-old woman had a delayed breast reconstruction using a free deep inferior epigastric perforator (DIEP) flap raised on a single medial row deep inferior epigastric perforator, complicated by intraoperative pedicle avulsion. Following a 1-cm excision of the intimally damaged vessel, the pedicle was repaired and the flap was salvaged using a supermicrosurgical technique.


1. What is supermicrosurgery?

2. What levels of pedicle injury can occur?

3. What are the intraoperative strategies to salvage the free flap from pedicle avulsion?

4. What scope is there for future advancements in free flap reconstruction using supermicrosurgery?