title: Thrombolytic therapy: what is its role in free flap salvage?
abstract: Thrombolytic agents have been demonstrated to improve free flap salvage in animal models. However, clinical evidence regarding their efficacy has been scant. The authors reviewed their experience with flap salvage using thrombolytic therapy in 1,733 free flaps from February 1990 to July 1998. Patients with intraoperative pedicle thrombosis were excluded from this review. Forty-one of the 55 free flaps that were reexplored emergently were identified as having pedicle thrombosis. Of these 41 flaps, 28 free flaps were salvaged (flap salvage group, 68%) and 13 free flaps failed (flap failure group, 32%). Thrombolytic therapy (urokinase in 7 patients, tissue plasminogen activator in 1 patient) was used in six flaps in the flap salvage group and two flaps in the flap failure group. Statistical analysis demonstrated no difference between the two groups with regard to thrombolytic therapy. There was also no difference between the two groups with regard to use of systemic heparin (100-500 U per hour) at the time of pedicle thrombosis or with regard to whether Fogarty catheters were used. Smoking, preoperative radiotherapy, and the use of interpositional vein grafts during initial flap reconstruction had no impact on the outcome of flap salvage. The flap salvage group was reexplored at a mean of 1.5 days compared with the flap failure group, which was reexplored at a mean of 4.2 days (p = 0.007). Early detection of pedicle thrombosis remains the most important factor in the salvage of free flaps. Although these numbers are small and definitive statements cannot be made, the role of thrombolytic agents in free flap salvage requires further clinical evaluation.
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: N W
authors.initials: NW
authors.lastname: Yii
authors.forename: G R
authors.initials: GR
authors.lastname: Evans
authors.forename: M J
authors.initials: MJ
authors.lastname: Miller
authors.forename: G P
authors.initials: GP
authors.lastname: Reece
authors.forename: H
authors.initials: H
authors.lastname: Langstein
authors.forename: D
authors.initials: D
authors.lastname: Chang
authors.forename: S S
authors.initials: SS
authors.lastname: Kroll
authors.forename: B
authors.initials: B
authors.lastname: Wang
authors.forename: G L
authors.initials: GL
authors.lastname: Robb
mesh_terms: D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D010960:Plasminogen Activators / Q000627:therapeutic use; D011183:Postoperative Complications; D011994:Recombinant Proteins / Q000627:therapeutic use; D013524:Surgical Flaps / Q000098:blood supply*; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D006493:Heparin; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator