Pharmacological thrombolysis: one more Weapon for Free flap salvage

Despite the high success rate of free-tissue transfer, thrombosis still complicates 530% of cases. Meticoulous technique,careful vessel selection, and pharmacological prophylaxis are not always enough to avoid thrombosis. Early diagnosis andreintervention provide the only way to salvage a thrombosed free flap, in case of either arterial or venous thrombosis. Whenkinking, torsion, or external compression of the pedicle are ruled out, and thrombectomy and redo of the anastomosis areunsuccessful, the last resort to save the flap is thrombolytic therapy. The authors present their experience with the salvage oftwo otherwise lost flaps by means of urokinase thrombolysis through direct intra-arterial injection with the vein left open toavoid systemic diffusion of the drug, and give technical tips to improve drug delivery to the flap. Pharmacological thrombolysisis an additional and effective weapon to resolve thrombosis, if properly used, to be considered by every reconstructivemicrosurgeon.