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.
KEYWORDS
Free flap salvage - tissue plasminogen activator - thrombolysis
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Brian D RinkerM.D.
Division of Plastic Surgery, University of Kentucky, Kentucky Clinic
K454 Lexington, KY 40536-0284
