Early rescue of a compromised anterolateral free thigh flap following hip disarticulation.

Abstract

Background:
Microvascular free tissue transfer is a cornerstone of reconstructive surgery, with high reported success rates. Nevertheless, free flap compromise remains a time-sensitive surgical emergency in which early recognition and prompt intervention are critical to flap survival.

Case:
We report the successful salvage of a compromised anterolateral thigh (ALT) free flap used for pelvic stump reconstruction following hip disarticulation in a 31-year-old patient with osteosarcoma. Early postoperative monitoring detected signs of venous compromise within the first 24 hours. Immediate surgical re-exploration revealed a perianastomotic hematoma, which was evacuated, restoring adequate perfusion without the need for pharmacologic or mechanical thrombectomy.

Results:
Prompt identification of vascular compromise and timely surgical intervention resulted in complete flap survival with satisfactory functional and clinical outcomes.

Conclusion:
This case highlights that structured postoperative monitoring and early surgical re-exploration remain the most reliable strategies for free flap salvage. Emphasis on practical perioperative decision-making may improve outcomes in high-risk microsurgical reconstruction.