title: Free flap salvage with subcutaneous injection of tissue plasminogen activator in head and neck patients.
abstract: In this report, we present our experience with subcutaneous rt-PA injection for salvage of free radial forearm flaps with vascular compromise. Three patients underwent reconstruction of defects of the soft palate or the lateral tongue with a free radial forearm flap. Patients underwent on average two attempted operative revisions with thrombectomy and intravenous heparin injections. After recurrent venous thrombosis 3-6 days after surgery, rt-PA (Alteplase 2 mg; 1,160,000 IE) was injected subcutaneously at multiple sites into the compromised flap as final attempt. In all three patients, successful thrombolysis with no or only partial soft tissue loss was achieved after subcutaneous injection of rt-PA. We therefore suggest subcutaneous rt-PA injection as an additional tool in managing difficult and recurrent cases of venous thrombosis in free flap head and neck reconstruction.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Germany.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Ihler
authors.forename: Christoph
authors.initials: C
authors.lastname: Matthias
authors.forename: Martin
authors.initials: M
authors.lastname: Canis
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D058752:Free Tissue Flaps / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery; D010157:Palatal Neoplasms / Q000601:surgery; D010160:Palate, Soft; D012008:Recurrence; D000077195:Squamous Cell Carcinoma of Head and Neck; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014062:Tongue Neoplasms / Q000601:surgery; D014067:Tonsillar Neoplasms / Q000601:surgery; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator