I am a microsurgeon. In my hands, I believe that a DIEP flap can offer the best reconstruction possible. But what happens when it all goes wrong? Every microsurgeon knows that there is, inherent in what we do, a risk of failure. We, as surgeons, accept this, but for the patient, this is a potentially devastating complication which has left them with scars, pain, and nothing else to show for the ordeal. So what happens when free flaps fail? I (like most microsurgeons I presume) have spent many sleepless nights worrying about this after a complex procedure. I think about the cases that have come to define the way in which I practice. I think about the failures and the near-misses. Those cases, and the lessons I have learnt, are invaluable to me but each one has come at a cost to a patient. Fortunately, I (and my patients) have had to suffer only very few failures. Some of us are less lucky. Even the best surgeons lose flaps. I won’t go into the reasons that free tissue transfer and microsurgery can go wrong (it can get complex), but just like any procedure, this type of surgery has risks. Any … Continue reading Microsurgery and reality: what happens when DIEP flaps fail