Vascular complications and microvascular free flap salvage: The role of thrombolytic agents

Abstract

The decreased incidence of fat necrosis may be attributable to dissolution of thrombi in the microvasculature with the administration of thrombolytics. Although the use of adjuvant thrombolytic therapy does not appear to impact the rate of flap salvage, their use may have secondary benefits on overall flap outcomes.

Comparison of the effects of different vasoactive and antiplatelet drugs on perforator flap viability. An experimental study

“…Chang et al used tissue plasminogen activator (tPA), streptokinase and urokinase for vascular complications of free flaps with encouraging results [15]. Low-molecular-weight heparin has been shown to help increase the survival rates of congested skin flaps [16].…”

Resurrection of an ALT flap with recombinant tissue plasminogen activator and heparin

“…On analysis of the literature it is clear that is no consensus on the amount of tPA used (Table 1) [8,[10][11][12]. The average amount used was 2.0 mg, but 2.5 mg and 4.0 mg has also been used.…”

Free flap salvage with subcutaneous injection of tissue plasminogen activator in head and neck patients

“…In 1987 Lipton and Jupiter, first reported pharmacological thrombolysis by administering streptokinase intra‐arterially for salvage of an osteocutaneous fibular free flap that suffered from venous pedicle thrombosis. Today, intra‐arterial administration is well‐described and many studies reported successful free flap salvage . Notwithstanding, late or recurrent flap thrombosis can be devastating and flap damage or even loss is common in such cases .…”

“…The window for intervention that may allow successful free flap salvage appears to be within the first 24 hours . However in difficult vascular conditions and recurrent cases of venous thrombosis, thrombolytic drugs have been described for salvage in addition to surgical revision, thrombectomy, and irrigation with heparin solution …”