Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap.
10.5999/aps.2013.40.3.251
- Author:
Dae Sung LEE
1
;
Sun Il JUNG
;
Deok Woo KIM
;
Eun Sang DHONG
Author Information
1. Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. prsdhong@korea.ac.kr
- Publication Type:Case Report
- Keywords:
Salvage therapy;
Free tissue flaps;
Tissue plasminogen activator
- MeSH:
Arteries;
Carcinoma, Squamous Cell;
Follow-Up Studies;
Free Tissue Flaps;
Glossectomy;
Humans;
Lidocaine;
Male;
Mouth Floor;
Neoplasm Metastasis;
Osteotomy;
Papaverine;
Salvage Therapy;
Thrombosis;
Tissue Donors;
Tissue Plasminogen Activator;
Urokinase-Type Plasminogen Activator
- From:Archives of Plastic Surgery
2013;40(3):251-255
- CountryRepublic of Korea
- Language:English
-
Abstract:
We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.
