Fig. 1.

Left, patient who underwent anterior skull base resection and orbital exenteration for malignant tumor underwent pericranial flap, cranioplasty, and left neck dissection with radial forearm free flap anastomosed to facial artery and external jugular vein. Pedicle marked by pen externally to remind nursing staff to avoid external compression. Patient subsequently taken immediately postoperatively within 1 hour for loss of arterial signal from implantable Doppler. Right, large thrombectomy along the length of the pedicle removed with microforceps and Tsai irrigation. Revision of anastomosis with favorable placement of pedicle relative to the internal jugular vein resulted in complete flap salvage.