Anterograde intra-arterial urokinase injection for salvaging fibular free flap

Dae Sung Lee, Sun Il Jung, Deok Woo Kim, Eun Sang Dhong

    Research output: Contribution to journalArticlepeer-review

    6 Citations (Scopus)

    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.

    Original languageEnglish
    Pages (from-to)251-255
    Number of pages5
    JournalArchives of Plastic Surgery
    Volume40
    Issue number3
    DOIs
    Publication statusPublished - 2013

    Keywords

    • Free tissue flaps
    • Salvage therapy
    • Tissue plasminogen activator

    ASJC Scopus subject areas

    • Surgery

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