Arch Hand Microsurg 2018; 23(2): 121-125  
An Iatrogenic Flap Necrosis Case: Factors to Consider for Successful Flap Elevation
Non Hyeon Ha, Ill Jae Lee
Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
Correspondence to: Ill Jae Lee
Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, 164 WorldCup-ro, Yeongtong-gu, Suwon 16499, Korea
TEL: +82-31-219-5614, FAX: +82-31-219-5610, E-mail:
Received: April 9, 2018; Revised: May 5, 2018; Accepted: May 14, 2018; Published online: June 1, 2018.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The free flap technique has been used for lower limb reconstruction. Still, the free flap itself and related surgical procedures are challenging process, because there’s a lot of factors to consider for successful outcome. We report a case of total flap necrosis due to inadequate flap elevation on the left ankle of a young man. Although the shape of the elevated flap was not fit into rectangular shape exactly, the length to width ratio of the flap was almost 2.25:1. The circulation to the tissue was not enough to flap survival, due to inadequate incision. To prevent flap mismanagement, all the surgical procedure should be performed based on a thorough understanding of flap related knowledge, such as length-width ratio restriction of elevated flap, angiosome and proper surgical incision. Also we recommend swell-timed consultation with surgeons trained in microsurgery for guidance regarding flap evaluation and its subsequent management.
Keywords: Free flaps, Microsurgery, Lower extremity, Angiosome

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