Successful free flap salvage surgery with off-label use of Alteplase: A case report, review of the literature and our free flap salvage algorithm

Barhoum, F; Tschaikowsky, K.; Koch, Michael; Kapsreiter, M; Sievert, Matti; Müller, Sarina; Goncalves, Miguel; Traxdorf, Maximilian; Scherl, Claudia

doi:10.1016/j.ijscr.2020.09.035

Cited by 5 publications

(2 citation statements)

References 21 publications

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“…While the initial salvage rate of compromised free flaps demonstrates a high measure of success, there exists a small number of flaps that will develop vascular compromise a second time. In these cases, the rate of a second successful revascularization is unknown …”

Section: Introductionmentioning

confidence: 99%

“…In these cases, the rate of a second successful revascularization is unknown. 1,4,5 This cohort study aims to determine the outcomes following the salvage of free flaps demonstrating a second episode of compromise following prior successful revascularization. Additionally, the factors associated with success and failure of second salvage attempts are investigated.…”

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confidence: 99%

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Success and Outcomes Following a Second Salvage Attempt for Free Flap Compromise in Patients Undergoing Head and Neck Reconstruction

Slijepcevic

Young

Shinn

et al. 2022

JAMA Otolaryngol Head Neck Surg

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free flap compromise is low, with successful salvage in up to 70%. When the flap is compromised a second time, the value of intervening is unknown.OBJECTIVE To assess the outcomes of a second revascularization attempt for compromised free flaps. DESIGN, SETTING, AND PARTICIPANTSThis multicenter retrospective medical record review included patients undergoing head and neck reconstruction with free flaps at 6 US medical centers from January 1, 2000, through December 30, 2020. Patients were 18 years or older with a history of head and neck defects from cancer, osteoradionecrosis, or other wounds. Of 3510 flaps identified, 79 were successfully salvaged once, became compromised a second time, and underwent attempted salvage. MAIN OUTCOME AND MEASUREFlaps with a history of initial compromise and successful revascularization demonstrating second episodes of compromise followed by second salvage attempts.RESULTS A total of 79 patients (mean age, 64 years; 61 [77%] men) were included in the analysis. Of the 79 flaps undergoing second salvage attempts, 24 (30%) survived while 55 (70%) demonstrated necrosis. Arterial or venous thrombectomy was performed in 17 of the 24 (71%) flaps that survived and 23 of the 55 (42%) flaps demonstrating necrosis (odds ratio, 3.38; 95% CI, 1.21-9.47). When venous compromise was encountered, changing the anastomotic vein was associated with decreased survival compared with not changing the vein (29 of 55 [53%] flaps vs 10 of 24 [42%] flaps); vein revision to an alternative branch was completed in 1 of the 24 (4%) flaps that survived and 19 of the 55 (35%) flaps with necrosis (odds ratio, 0.08; 95% CI, 0.00-0.60). Factors that were not associated with flap survival following second salvage attempts included flap type, cause of flap failure, postoperative complications, patient comorbidities, and heparin administration after second salvage. CONCLUSIONS AND RELEVANCEIn this cohort study, second salvage was successful in 30% of free flaps. Flaps that underwent arterial or venous thrombectomy demonstrated better survival, while vein revision to neighboring branch veins was associated with worse flap outcomes.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%