Salvage of Free Tissue Transfers Using Thrombolytic Agents

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Abstract
During the period 1985 to 1988, salvage of free tissue transfers with streptokinase and urokinase was performed in six patients with 83.3 percent success. The no-reflow phenomenon, manifested by poor intraflap flow in spite of a patient arterial anastomosis, was present in four successful patients. Streptokinase was used in four patients with 100 percent success with a dose range of 50,000 to 125,000 U. Urokinase was used in two patients with 50 percent success with a dose range of 50,000 to 100,000 U. Successful cases were reexplored within 6 hr of indication of ischemia. The unsuccessful case was reexplored 9 hr after ischemia as indicated by a laser Doppler flowmeter. Subflap hematoma occurred in one patient. A technique is described that selectively perfuses the free flap with the thrombolytic agent and prevents systemic complications.

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