title: Microvascular thrombolysis to salvage a free flap using human recombinant tissue plasminogen activator.
abstract: Nonsurgical thrombolysis using tissue plasminogen activator (t-PA) in conjunction with intravenous heparin infusion was successfully used to salvage a free flap with acutely decreased arterial inflow thought to be due to anastomotic thrombosis. Intravenous infusion (12 mg/hr) of t-PA was stopped after 15 min of therapy when spontaneous bleeding was noted at the groin flap donor site. Concomitant treatment with intravenous heparin resulted in rapid improvement of flap perfusion and ultimately complete survival without surgical intervention. This report suggests that in selected cases, target-specific anticoagulant therapy may be beneficial in salvaging microvascular reconstructions complicated by thrombosis. Further experience is warranted to define more clearly the role, the risks, and the extended benefits of this new mode of nonsurgical therapy.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Massachusetts Medical Center, Worcester 01655.
authors.forename: G M
authors.initials: GM
authors.lastname: Fudem
authors.forename: R L
authors.initials: RL
authors.lastname: Walton
mesh_terms: D000328:Adult; D018409:Foot Injuries; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013524:Surgical Flaps; D013927:Thrombosis / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D011994:Recombinant Proteins; D006493:Heparin; D010959:Tissue Plasminogen Activator