ArticleJPRAS open2026
The survival of a free flap after post-operative cardiac arrest and cardiopulmonary resuscitation in an 85-year-old female: A case report and literature review.
Article in JPRAS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Cardiac arrest rarely occurs during or after free flap surgery, and although multiple studies have reported the outcomes of in-hospital cardiac arrest, studies describing the outcomes of free flaps in patients who were successfully resuscitated after cardiac arrest are rare. We present herein the case of an 85-year-old woman who underwent an excisional biopsy after presenting to our dermatology department with a rapidly growing subcutaneous mass in her left forearm. A pathological examination of the biopsy specimen revealed the mass to be a malignant tumour; therefore, the patient subsequently underwent an extended excision, resulting in a 100 × 250 mm defect in the dorsum of her left forearm. The defect was successfully reconstructed using a free anterolateral thigh flap from the right leg; however, 2 days post-reconstruction, the patient experienced cardiopulmonary arrest. Spontaneous circulation was returned after 10 min of cardiopulmonary resuscitation, during which 2 mg of adrenaline was administered. The free flap was closely observed for >30 days post-arrest and showed no signs of necrosis or infection during that time. The patient was transferred to a nursing facility on day 53 post-arrest owing to the loss of high cognitive function. Our institution has encountered two other cases of post-operative cardiac arrest after free flap transfer in the past 8 years, and a literature search of PubMed returned three documented cases of free flap survival after cardiac arrest and resuscitation. This case report and literature review aimed to demonstrate the characteristics of the free flaps that survived cardiac arrest and subsequent resuscitation. An analysis of these six aforementioned cases of free flaps that survived cardiac arrest demonstrated that post-operative cardiac arrest and cardiopulmonary resuscitation may not significantly decrease the survival of free flaps.
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