Reversible No-Reflow Phenomenon in a Free Flap after 16 Hours

A patent vascular tree within the flap and anastomosis are quintessential for the success of a microvascular free flap. Any thrombus or vasoconstriction severely affects the blood flow in the flap. Intraoperative ischemia time also plays a major role in the flap. Various clinical and objective methods have been designed that help in the postoperative monitoring and timely intervention to reverse an impending free flap failure by identifying the cause. Here, we discuss an interesting scenario about a free flap showing signs of flap failure (clinical and objective) during the immediate postoperative period up to 16 hours, but later on survived completely without active intervention.