Microvascular free tissue transfer in the setting of COVID-19 associated coagulopathy: A case report

In the era of this pandemic, the use of free flaps for elective reconstruction should proceed with caution in the COVID-19 positive patient given the associated coagulopathy. In those who require free tissue transfer in an urgent or non-elective manner, it is advisable to consider systemic anticoagulation with an associated hematologic consultation given the theoretic higher risk of flap vascular complication. We present a case report of a young healthy and otherwise asymptomatic COVID-19 positive patient whose associated coagulopathy resulted in free flap loss and need for further operations. •Patients with COVID-19 can present with coagulopathy which can cause flap loss.•When considering free tissue transfer anticoagulation should be considered.•An intraoperative thromboelastogram can be helpful to guide management.•End-to-side anastomosis and flaps with lower vascular resistance are suggested.