DOI QR코드

DOI QR Code

Primary thrombolysis for free flap surgery in head and neck reconstruction: a case report and review

  • Zhang, Steven Liben (Section of Plastic, Reconstructive and Aesthetic Surgery, Department of General Surgery) ;
  • Ng, Hui Wen (Section of Plastic, Reconstructive and Aesthetic Surgery, Department of General Surgery)
  • Received : 2021.01.16
  • Accepted : 2021.05.27
  • Published : 2021.09.15

Abstract

The use of free flaps is an essential and reliable method of reconstruction in complex head and neck defects. Flap failure remains the most feared complication, the most common cause being pedicle thrombosis. Among other measures, thrombolysis is useful when manual thrombectomy has failed to restore flap perfusion, in the setting of late or established thrombosis, or in arterial thrombosis with distal clot propagation. We report a case of pedicle arterial thrombosis with distal clot propagation which occurred during reconstruction of a maxillectomy defect, and was successfully treated with thrombolysis using recombinant tissue plasminogen activator. We also review the literature regarding the use of thrombolysis in free flap surgery, and propose an algorithm for the salvage of free flaps in head and neck reconstruction.

Keywords

References

  1. Bui DT, Cordeiro PG, Hu QY, et al. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg 2007;119:2092-100. https://doi.org/10.1097/01.prs.0000260598.24376.e1
  2. Chiu YH, Chang DH, Perng CK. Vascular complications and free flap salvage in head and neck reconstructive surgery: analysis of 150 cases of reexploration. Ann Plast Surg 2017;78(3 Suppl 2):S83-8. https://doi.org/10.1097/SAP.0000000000001011
  3. Casey WJ 3rd, Craft RO, Rebecca AM, et al. Intra-arterial tissue plasminogen activator: an effective adjunct following microsurgical venous thrombosis. Ann Plast Surg 2007;59:520-5. https://doi.org/10.1097/01.sap.0000258971.73613.65
  4. Hanasono MM, Butler CE. Prevention and treatment of thrombosis in microvascular surgery. J Reconstr Microsurg 2008;24:305-14. https://doi.org/10.1055/s-2008-1080530
  5. Rinker BD, Stewart DH, Pu LL, et al. Role of recombinant tissue plasminogen activator in free flap salvage. J Reconstr Microsurg 2007;23:69-73. https://doi.org/10.1055/s-2007-970185
  6. Lipton HA, Jupiter JB. Streptokinase salvage of a free-tissue transfer: case report and review of the literature. Plast Reconstr Surg 1987;79:977-81. https://doi.org/10.1097/00006534-198706000-00022
  7. Panchapakesan V, Addison P, Beausang E, et al. Role of thrombolysis in free-flap salvage. J Reconstr Microsurg 2003;19:523-30. https://doi.org/10.1055/s-2004-815638
  8. Bonde CT, Heslet L, Jansen E, et al. Salvage of free flaps after venous thrombosis: case report. Microsurgery 2004;24:298-301. https://doi.org/10.1002/micr.20024
  9. Yii NW, Evans GR, Miller MJ, et al. Thrombolytic therapy: what is its role in free flap salvage? Ann Plast Surg 2001;46:601-4. https://doi.org/10.1097/00000637-200106000-00005
  10. Serletti JM, Moran SL, Orlando GS, et al. Urokinase protocol for free-flap salvage following prolonged venous thrombosis. Plast Reconstr Surg 1998;102:1947-53. https://doi.org/10.1097/00006534-199811000-00021
  11. Chang EI, Mehrara BJ, Festekjian JH, et al. Vascular complications and microvascular free flap salvage: the role of thrombolytic agents. Microsurgery 2011;31:505-9. https://doi.org/10.1002/micr.20905
  12. Hong KY, Chang LS, Chang H, et al. Direct thrombectomy as a salvage technique in free flap breast reconstruction. Microsurgery 2017;37:402-5. https://doi.org/10.1002/micr.30119