Early survival of a compromised fasciocutaneous flap without pedicle revision: monitoring with photoplethysmography.

While free flaps are reliant on their vascular pedicle for survival intraoperatively and for a variable period of time postoperatively, there have been reports of late pedicle compromise after which complete flap survival has ensued. Successful neovascularization and revascularization at the edges of a flap in such cases result in the flap becoming independent of its pedicle. We report a case in which free flap survival occurred following pedicle compromise before postoperative day seven. The use of preoperative computed tomographic angiography (CTA) assessment to map flap vasculature was able to demonstrate the intrinsic vascular anatomy of the flap, and both clinical assessment and photoplethysmography (PPG) assessment of cutaneous blood flow obtained during and after flap compromise were able to highlight the changes in flap perfusion. With complete flap survival despite the lack of pedicle revision, the roles for close monitoring with clinical assessment and PPG, and delaying debridement are discussed.