Arch Plast Surg.  2013 May;40(3):251-255. 10.5999/aps.2013.40.3.251.

Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. prsdhong@korea.ac.kr

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.

Keyword

Salvage therapy; Free tissue flaps; Tissue plasminogen activator

MeSH Terms

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
Lidocaine
Papaverine
Tissue Plasminogen Activator
Urokinase-Type Plasminogen Activator
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