Journal of Biomedical and Clinical Research 19: 31-41, doi: 10.3897/jbcr.e182885
Venous congestion in pedicled flaps for reconstruction of complex soft-tissue defects. Our experience
Kaloyan Tonev‡, Zhivko Dimitrov‡, Toni Stoyanov§‡ UMHAT Medika, Rousse, Bulgaria§ Unit of Endocrine and Bariatric Surgery, Department of General Surgery, University Hospital Center Albacete, Albacete, Spain
Corresponding author: Kaloyan Tonev ( ktonevmd@gmail.com ) Academic editor: Galya Stavreva © Kaloyan Tonev, Zhivko Dimitrov, Toni Stoyanov. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Citation:
Tonev K, Dimitrov Z, Stoyanov T (2026) Venous congestion in pedicled flaps for reconstruction of complex soft-tissue defects. Our experience. Journal of Biomedical and Clinical Research 19: 31-41. https://doi.org/10.3897/jbcr.e182885 |  |
Abstract
We present three cases of reconstruction of complex skin defects using pedicled flaps (gracilis, pectoralis major, and TRAM), all of which postoperatively exhibited venous congestion, characterized by cyanosis, edema, and dark bleeding on pinprick. While cumulative comorbidities increased the overall risk, potential mechanical causes included pedicle torsion or compression, hematoma, and skin–muscle island mismatch. Empirical treatment included therapeutic anticoagulation, decompression (partial suture removal and punctures), and operative revision when indicated. We compared these measures against existing literature. Because venous congestion led to partial flap loss in our series, we propose prevention and management strategies, including meticulous planning, gentle surgical technique, and early intervention, all of which are crucial for successful flap salvage.
Keywords
Gracilis, partial necrosis, pectoral flap, pedicled flap, reconstructive surgery, TRAM, venous congestion