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OTORINOLARINGOLOGIA

A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery


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Otorinolaringologia 2008 March;58(1):87-91

language: English

Urokinase in free flap rescue

Agostini T.

Department of Plastic and Reconstructive Surgery Faculty of Medicine and Surgery University of Florence, Florence, Italy


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The reported incidence of free flap failure varies from 4% to 5%, but pedicle thrombosis occurs in a higher percentage than indicated by the failure rate, the difference resulting from successful salvage of failing flaps. Often these failures are attributed to postoperative venous thrombosis, reported salvages being 42%; the poorer salvage rate in case of venous thrombosis has been related to a delay in recognition, because of the ongoing presence of an arterial Doppler signal. The physical engorgement of the flap and the microvascular changes lead to a more rapid and less reversible no-reflow phenomenon, occurring within 6 hours. This report shows the efficacy of thrombolytic therapy after 6 hours, confirming that the mechanism of free flap failure is not yet well known. A reliable and simple protocol of thrombolytic therapy applied in a well documented case of vascular compromise is described. Urokinase is the drug chosen to treat the thrombosis, owing to its easy availability, low cost, short half-life and absence of antigenicity.

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