Late partial failure of a free ALT flap

Summary Late failure of microsurgical flaps is a rare event and it has been reported as a consequence of compression of the vascular pedicle or late infection. We report a case of late partial failure occurring 3 weeks post-operatively which was shown by vascular imaging to be caused by a previously unidentified complete occlusion of the right external iliac artery. After successful vascular bypass surgery, the suffering flap developed granulation tissue and was skin grafted. In patients carrying multiple risk factors for peripheral vascular disease, the risk of proximal vessel occlusion as a cause of flap failure, should be kept in mind.