Literature and own experimental data on the causes of arterial anastomotic thrombosis are analyzed in the manuscript. Features and technical errors of vascular suture are shown. The authors discuss the features of arterial perfusion of free flaps and predictors (risk factors) of arterial anastomotic thrombosis. Current ideas about thrombolysis in the management of anastomotic thrombosis and reperfusion injury are described.

Keywords. microsurgical flaps, arterial anastomotic thrombosis, fascial skin flap, vascular suture technique, risk factors of thrombosis, thrombolysis