Pharmacological thrombolysis: one more weapon for free-flap salvage.
Despite the high success rate of free-tissue transfer, thrombosis still complicates 5-30% of cases. Meticoulous technique, careful vessel selection, and pharmacological prophylaxis are not always enough to avoid thrombosis. Early diagnosis and reintervention provide the only way to salvage a thrombosed free flap, in case of either arterial or venous thrombosis. When kinking, torsion, or external compression of the pedicle are ruled out, and thrombectomy and redo of the anastomosis are unsuccessful, the last resort to save the flap is thrombolytic therapy. The authors present their experience with the salvage of two otherwise lost flaps by means of urokinase thrombolysis through direct intra-arterial injection with the vein left open to avoid systemic diffusion of the drug, and give technical tips to improve drug delivery to the flap. Pharmacological thrombolysis is an additional and effective weapon to resolve thrombosis, if properly used, to be considered by every reconstructive microsurgeon.
D'Arpa
Salvatore
S
Dipartimento di Discipline Chirurgiche ed Oncologiche, Cattedra di Chirurgia Plastica e Ricostruttiva, Università degli Studi di Palermo, Palermo, Italy. turidarpa@hotmail.com
Cordova
Adriana
A
Moschella
Francesco
F
D000328:Adult; D000369:Aged, 80 and over; D006085:Graft Survival; D006801:Humans; D008297:Male; D013524:Surgical Flaps / Q000098:blood supply*; D015912:Thrombolytic Therapy / Q000379:methods*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D020246:Venous Thrombosis / Q000188:drug therapy*
D014568:Urokinase-Type Plasminogen Activator