LAUSR

Thrombosis in the free flap patient poses potentially the most significant risk factor for either partial or total flap failure. While prevention of thromboembolic complications can be achieved through careful vessel handling and the use of adjunctive pharmacological anti-coagulants, other risk factors including coagulopathic disorders are more difficult to control for. Of these, hereditary anti-thrombin III deficiency is well established to confer the highest risk for thromboembolic events among the documented hereditary thrombophilias. We present the first reported case of bilateral free flap breast reconstruction in a patient with a known history of anti-thrombin III deficiency. We discuss our approach to this case, including a suggested guideline for the management of the free flap patient with anti-thrombin III deficiency. Level of evidence: Level V, therapeutic study.