title: Delayed free flap salvage after venous thrombosis.
abstract: The incidence of free flap failure is reported at 4% to 5%,but pedicle thrombosis occurs in a higher percentage, with the difference resulting from successful salvage of failing flaps. Often, these failures are attributed to postoperative venous thrombosis with salvage reported at 42%. The venous engorgement of the flap and the resulting microvascular changes lead to a more rapid and less reversible no-reflow phenomenon established within 6 hours. However, this report shows successful free flap salvage with thrombolytic drugs after 6 hours, highlighting that the mechanisms of free flap failure are still poorly understood.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Florence, Florence, Italy. tommasoagostini@ymail.com
authors.forename: Tommaso
authors.initials: T
authors.lastname: Agostini
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
authors.forename: Vittorugo
authors.initials: V
authors.lastname: Agostini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Spinelli
authors.forename: Kayvan
authors.initials: K
authors.lastname: Shokrollahi
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002610:Cheek; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D058752:Free Tissue Flaps / Q000098:blood supply*; D006084:Graft Rejection; D006801:Humans; D008833:Microcirculation; D009062:Mouth Neoplasms / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D016879:Salvage Therapy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000150:complications* / Q000188:drug therapy*
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator