Six hours after free-flap reconstruction, the skin paddle becomes congested, dark and rapidly refills after blanching. What is the best response?
Venous congestion is time-critical. Clinical signs and Doppler findings should trigger rapid exploration because salvage probability falls with delay; observation for morning review is unsafe.
A. Apply topical steroid and observe overnight: This does not correct pedicle thrombosis or kinking.
B. Remove all sutures on the ward without a plan: Uncontrolled manipulation can damage the flap and delay definitive exploration.
C. Wait for tissue necrosis to demarcate: That forfeits the window for flap salvage.
D. Start oral antibiotics only: Infection does not explain the immediate vascular pattern.
E. Immediate senior review and urgent return to theatre for suspected venous compromise: Venous congestion is time-critical. Clinical signs and Doppler findings should trigger rapid exploration because salvage probability falls with delay; observation for morning review is unsafe.
If the flap were pale, cool and lacked capillary refill, arterial inflow failure would be suspected, but exploration would remain urgent.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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