Role of recombinant tissue plasminogen activator in free flap salvage

Brian D. Rinker, Daniel H. Stewart, Lee Li-Qun Pu, Henry C. Vasconez

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

The use of recombinant tissue plasminogen activator (rTPA) in microvascular surgery has been previously reported, but no consensus exists regarding its indications, dose, efficacy, or safety. The records of all patients undergoing free tissue transfer at one institution between 2000 and 2005 were reviewed. Patients requiring reexploration for pedicle thrombosis were identified. Chi-square and the two-sided Fisher's exact tests were used to compare differences between the two groups. Two hundred seventy-five free flaps were performed in 259 patients. In 27 cases (10 percent), reexploration for impending failure was performed, and pedicle thrombosis was observed in 22 cases. In 15 cases, rTPA was administered. Ten of these flaps (67 percent) were successfully salvaged, compared to 2/7 (29 percent) in the no-rTPA group. Heparin was used in 12 patients but was not associated with a higher salvage rate. These findings suggest that the isolated perfusion of rTPA in the salvage of the failing free flap may be more effective than anastomotic revision alone and should be considered when vascular thrombosis is encountered on reexploration of the failing free flap.

Original languageEnglish (US)
Pages (from-to)69-73
Number of pages5
JournalJournal of Reconstructive Microsurgery
Volume23
Issue number2
DOIs
StatePublished - Feb 2007
Externally publishedYes

Keywords

  • Free flap salvage
  • Thrombolysis
  • Tissue plasminogen activator

ASJC Scopus subject areas

  • Surgery

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