 Acute complications involving the vascular structures of the flap can be either partial or complete occlusion of the artery or vein going to and from the tissue flap. Both pedicle and free tissue transfer flaps can develop severe complications if either the artery or vein is compromised, including complete death of the tissue in the flap. If the vascular structures going to the flaps are compromised then the tissues used for reconstructive surgery may undergo damage. This tissue damage can become extensive and result in the loss of part or the entire tissue mass in the tissue transfer flap, which in turn can result in increased morbidity and mortality to the patient. In the reconstructive surgery literature, it has been shown that frequent monitoring during the first 48-72 hours after reconstructive surgery allows for early detection and intervention when a vascular compromised flap occurs. This earlier detection then can translate into earlier interventions including surgical re-exploration, which has been shown to improve the salvage rates of vascular compromise of the tissue transfer flaps.8, 9 It is generally known that venous thrombosis has a worse out-come, when compared to arterial thrombosis after surgical re-exploration and reestablishment of blood flow. This difference between arterial and venous thrombosis is thought to be due to the differences in the pathophysiology involved in venous congestion. In venous thrombosis tissue fluid content is increased due to initially continued arterial inflow, thus when venous out-flow is re-established the tissue edema continues to inhibit the diffusion of oxygen through the interstitial space from the capillaries to the tissue cells in the vascular beds were edema remains. The fact that venous thrombosis is more difficult to clinically detect early may also contribute to the poorer prognosis associated with venous thrombosis when compared to arterial thrombosis.10 