Venous congestion in pedicled flaps for reconstruction of complex soft-tissue defects. Our experience

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.