Successful Treatment of Delayed Partial Flap Loss in Autologous Breast Reconstruction With Rivaroxaban

Modern free flap breast reconstruction has high levels of success and patient satisfaction. When delayed microvascular complications do arise, corresponding salvage rates are low. Here, we present the case of a 72-year-old female who underwent uneventful right autologous breast reconstruction using profunda artery perforator (PAP) stacked flaps, whose course was complicated at postoperative day eight by partial superior flap congestion. Successful salvage of the superior PAP flap was achieved after three weeks of rivaroxaban treatment. To our knowledge, this case is the first in the literature to suggest the potential benefit of systemic anticoagulation in treating delayed partial flap congestion.