Thrombolysis in microvascular surgery using tissue-type plasminogen activator

Archives of Otolaryngology--head & Neck Surgery
J E Romano, M A Biel

Abstract

Thrombosis at the microanastomotic site is the primary cause of free flap failure. Tissue-type plasminogen activator, a potent thrombolytic agent, effectively lyses vessel thromboses. This study examined the efficacy of tissue-type plasminogen activator in a microvascular model using a modified vascular inversion graft in rabbits. Seventeen rabbits underwent this procedure with formation of thromboses in all but one inversion graft. Ten rabbits were locally infused with 1 mg of tissue-type plasminogen activator over a period of 4 hours; 6 control rabbits received normal saline infusions. Blood flow across the graft was reestablished in all 10 rabbits receiving tissue-type plasminogen activator and in none of those with normal saline infusions. Systemic fibrinolysis was not significantly altered. We conclude that local infusion of tissue-type plasminogen activator is effective in lysing thromboses that may occur at the venous microvascular anastomotic site without significant activation of systemic fibrinolysis.

Citations

Mar 13, 2008·Microsurgery·Andrew P TrusslerChristopher A Crisera
Jun 5, 2013·Archives of Plastic Surgery·Dae-Sung LeeEun-Sang Dhong
Jan 1, 1996·Microsurgery·A Atchabahian, A C Masquelet
Sep 1, 1991·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·J E Romano, M A Biel

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