Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap
Archives of Plastic Surgery
; : 251-255, 2013.
Article
de En
| WPRIM
| ID: wpr-157831
Bibliothèque responsable:
WPRO
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.
Mots clés
Texte intégral:
1
Indice:
WPRIM
Sujet Principal:
Ostéotomie
/
Papavérine
/
Artères
/
Thrombose
/
Donneurs de tissus
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Carcinome épidermoïde
/
Activateur du plasminogène de type urokinase
/
Études de suivi
/
Thérapie de rattrapage
/
Activateur tissulaire du plasminogène
Type d'étude:
Observational_studies
/
Prognostic_studies
Limites du sujet:
Humans
/
Male
langue:
En
Texte intégral:
Archives of Plastic Surgery
Année:
2013
Type:
Article