>Objective: Reconstructive surgeons are aware that deep vein thromboses can cause a free flap to fail; however, there are no reports in the literature regarding the incidence of free flap failure in the presence of superficial vein thromboses. >Methods: A 38-year-old white male patient with poorly controlled type I diabetes mellitus presented with a chronically infected ulcer overlying an osteomyelitic right distal tibia. This region was reconstructed with a musculocutaneous latissimus dorsi free flap. >Results: A superficial vein thrombosis was found 21 cm distant from the venous anastomosis of a free latissimus dorsi myocutaneous flap causing venous congestion. After early exploration, this flap was salvaged by resection of the compromised superficial venous system and the use of an interposition vein graft as no other suitable recipient vein was available. >Conclusions: This case may serve as a reminder to explore early and be aware that the crux of a complication may be at a distance from the operative field. Consideration must be given to the possible need for interposition vein grafts when a suitable local deep or superficial recipient vein is not available in the lower limb.
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