Flap salvage in a "flow-through" flap by manual thrombectomy plus thrombolytic therapy.
A delay in identifying incipient flap failure may inevitably lead to complete pedicle thrombosis and the no-reflow phenomenon. The authors report a clinical case of a lateral arm free flap that suffered complete pedicle thrombosis. They successfully salvaged this flap, a type C fasciocutaneous "flow-through" flap, by manually moving the thrombus from proximal to distal in the main flap artery. This freed the septofasciocutaneous upward-perforating branches, by smoothing and applying firm pressure to the vessel, combined with thrombolytic therapy. Their technique is offered as an alternative procedure for salvaging a failing flow-through flap.
Wechselberger
G
G
University Hospital of Plastic and Reconstructive Surgery, Leopold-Franzens University of Innsbruck, Austria.
Schoeller
T
T
Ohler
K
K
Anderl
H
H
Ninković
M
M
D000328:Adult; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008833:Microcirculation; D011183:Postoperative Complications; D013300:Streptokinase / Q000627:therapeutic use; D013524:Surgical Flaps / Q000098:blood supply; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000628:therapy; D017211:Treatment Failure
D005343:Fibrinolytic Agents; D013300:Streptokinase