Pharmacological thrombolysis: the last choice for salvaging free flaps

Management of free flap salvage using thrombolytic drugs: A systematic review

“…5 Namgoong et al described partial necrosis after time lag (11 hours) between the diagnosis of the flap problem and revision surgery. 36 Analysis of the studies reviewed revealed that streptokinase was used less than urokinase in cases of microvascular compromise. 4 , 5 , 11 , 17 , 24 , 26 , 37-40 Solution dose range was between 7500 and 250,000 units diluted in 10-30 cc of normal saline with which the flap was irrigated via the arterial pedicle.…”

Continuous local intravenous heparin infusion after re‐exploration for venous congestion in free‐flap breast reconstruction: A case series

“…Various methods to improve salvage rates after re‐exploration for venous congestion have been described 2 . Among these, the administration of anticoagulants or thrombolytic agents is considered to be an effective method 3‐5 . We demonstrated local intravenous heparin infusion to salvage flaps after re‐exploration for postoperative venous congestion after free‐flap breast reconstruction.…”

Ex Vivo Machine Thrombolysis Reduces Rethrombosis Rates in Salvaged Thrombosed Myocutaneous Flaps in Swine

“…3 Various techniques can be used to salvage the flap, such as surgical revision of the anastomosis, mechanical thrombectomy, and administration of heparin solution and/or thrombolytic drugs. 4 However, these interventions are successful in only 50 to 70 percent of cases, depending…”

“…3 Various techniques can be used to salvage the flap, such as surgical revision of the anastomosis, mechanical thrombectomy, and administration of heparin solution and/or thrombolytic drugs. 4 However, these interventions are successful in only 50 to 70 percent of cases, depending on the timing of salvage. 5 Failures may also occur while the anastomoses are still patent, including occlusion of the intrinsic vascular tree of the flap downstream from the anastomosis.…”