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CC BY-NC 4.0 · Arch Plast Surg 2021; 48(05): 511-517
DOI: 10.5999/aps.2021.00171
Pediatric/Craniomaxillofacial/Head&Neck
Case Report

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

Steven Liben Zhang 
Section of Plastic, Reconstructive and Aesthetic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
,
Hui Wen Ng 
Section of Plastic, Reconstructive and Aesthetic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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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

Thrombolytic therapy - Free tissue flaps - Reconstructive surgical procedures - Surgery, plastic - Fibrinolytic agents


Publication History

Received: 16 January 2021

Accepted: 27 May 2021

Article published online:
19 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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