CASE REPORTS   

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

Copyright © 2008 EDIZIONI MINERVA MEDICA

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

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.