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J Reconstr Microsurg 2015; 31(07): 544-546
DOI: 10.1055/s-0035-1555011
Letter to the Editor: Short Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Eptifibatide Salvage of Arterial Anastomotic Thrombosis in Lower Extremity Free Flap Reconstruction: A Case Report

Tessa Drijkoningen
1   Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Vincent van Weel
2   Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
,
Kyle R. Eberlin
1   Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Curtis L. Cetrulo Jr.
1   Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
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Publication History

16 January 2015

25 April 2015

Publication Date:
26 June 2015 (online)

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Free flap reconstruction conforms to three-dimensional wounds and has an important role in complex soft tissue defects in lower extremities.[1] Yazar et al showed complete flap survival rates of ± 93% in free muscle flap reconstructions of distal third open tibial fractures; some debate remains about indications for free muscle versus free fasciocutaneous flaps.[2] The most common cause for reexploration and microvascular failure is perianastomotic thrombosis, with arterial thrombosis less common than venous thrombosis.[3] Urokinase and alteplase are therapeutic options that have been used to successfully salvage free flap reconstruction.[4]

Eptifibatide (Integrilin, Millennium Pharmaceuticals, Cambridge, MA) is a drug of the glycoprotein IIb/IIIa-inhibitor class. We present a case of successful salvage with a partial superior latissimus dorsi free muscle flap in a patient with thrombocytosis and intraoperative arterial anastomotic thrombosis using intra- and postoperative administration of eptifibatide combined with heparin infusion.

 

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