title: Venous congestive flap salvage with subcutaneous rtPA.
abstract: Free-flap success has been the rule with technical advancements in microsurgery. Despite improvements, thrombosis and flap loss still occur occasionally. Salvaging a sick flap can be a harrowing experience, even in the most experienced hands. Thrombolysis using intravenous and intra-arterial urokinase, streptokinase, and/or tissue plasminogen activator (rtPA) administered through the flap vascular pedicle has been reported in free-flap salvages. In such situations, success depends on early diagnosis and emergent exploration. Recently, we successfully used rtPA subcutaneously to salvage a venous congested free transverse rectus abdominus myocutaneous (TRAM) flap. Here, we report on that case.
authors.affiliation: Division of Plastic Surgery, Mayo Clinic, Rochester, MN 55905, USA. tran.nho@mayo.edu
authors.forename: Nho V
authors.initials: NV
authors.lastname: Tran
authors.forename: Allen T
authors.initials: AT
authors.lastname: Bishop
authors.forename: Phyllis A
authors.initials: PA
authors.lastname: Convery
authors.forename: Art Y
authors.initials: AY
authors.lastname: Yu
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery; D004487:Edema / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008408:Mastectomy; D017568:Rectus Abdominis; D012008:Recurrence; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply*; D017131:Thrombectomy; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014656:Vascular Surgical Procedures; D014689:Venous Insufficiency / Q000188:drug therapy* / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator