Salvage of a congested DIEAP flap with subcutaneous recombinant tissue plasminogen activator treatment

Free flap salvage with subcutaneous injection of tissue plasminogen activator in head and neck patients

“…Two hours after injection of rt-PA the authors observed capillary refill and the return of a cutaneous Doppler signal. Comparable results were reported by Ayhan et al 23 who injected rt-PA subcutaneously into a compromised free deep inferior epigastric artery perforator flap. After renewing the venous anastomosis for three times venous congestion still reoccurred.…”

“…The injection of 2 mg of rt‐PA into multiple sites of the flap was followed by a return of capillary refill several hours later. Response times after subcutaneous injection of rt‐PA into free flaps are divergent . In our report, return of capillary refill was seen between 4 and 8 hours after injection of rt‐PA.…”

Negative pressure wound therapy for the management of flaps with venous congestion

“…In these challenging scenarios, different nonsurgical salvage techniques have been described to solve this problem. These options include anticoagulant therapy (heparin and prostaglandin E1), manual massage to encourage drainage of the congested blood, placement of external catheters for venous drainage, subcutaneous injection of low‐molecular‐weight heparin or recombinant tissue plasminogen activator, use of a heat lamp to elevate the temperature of the flap, blood‐letting with intermittent needle puncture, and the prescription of medical and chemical leeches . The results from these nonoperative methods are not always satisfactory and some complications such as wound infection and hematoma formation can hamper wound healing and prolong the hospital stay.…”

Resurrection of an ALT flap with recombinant tissue plasminogen activator and heparin

“…1). Authors have also reported the use of subcutaneous tPA in DIEP and TRAM salvage for venous congestion [8,9]. The use of subcutaneous tPA could possibly reduce the degree of major fat necrosis secondary to venous thrombosis [8,9].…”

“…On analysis of the literature it is clear that is no consensus on the amount of tPA used (Table 1) [8,[10][11][12]. The average amount used was 2.0 mg, but 2.5 mg and 4.0 mg has also been used.…”