Abstract
The authors present the salvage of an anterolateral (ALT) thigh flap, which was congested secondary to venous thrombosis for a period of more than 12 h. This case report details the technical steps that were employed and the evidence base behind them.
Level of Evidence : Level V, therapeutic study.
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Khouri RK, Cooley BC, Kunselman AR, Landis JR, Yeramian P, Ingram D et al (1998) A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg 102(3):711–721
Basheer MH, Wilson SM, Lewis H, Herbert K (2008) Microvascular free tissue transfer in reconstruction of the lower limb. J Plast Reconstr Aesthet Surg 61(5):525–528
Chen HC, Chuang CC, Chen S, Hsu WM, Wei FC (1994) Selection of recipient vessels for free flaps to the distal leg and foot following trauma. Microsurgery 15(5):358–363
Chen KT, Mardini S, Chuang DC, Lin CH, Cheng MH, Lin YT, et al (2007) Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers. Plast Reconstr Surg 120(1):187–195
Draenert FG, Gosau M, Al Nawas B (2010) Management of venous thrombosis in fibular free osseomusculocutaneous flaps used for mandibular reconstruction: clinical techniques and treatment considerations. Head Face Med 6:8
Mirzabeigi MN, Wang T, Kovach SJ, Taylor JA, Serletti JM, Wu LC (2012) Free flap take-back following postoperative microvascular compromise: predicting salvage versus failure. Plast Reconstr Surg 130(3):579–589
Perez M, Sancho J, Ferrer C, Garcia O, Barret JP (2014) Management of flap venous congestion: the role of heparin local subcutaneous injection. J Plast Reconstr Aesthet Surg 67(1):48–55
Ayhan S, Uygur S, Kucukoduk I, Sencan A (2009) Salvage of a congested DIEAP flap with subcutaneous recombinant tissue plasminogen activator treatment. J Plast Reconstr Aesthet Surg 62(11):e453–e454
Tran NV, Buchel EW, Convery PA (2007) Microvascular complications of DIEP flaps. Plast Reconstr Surg 119(5):1397–1405, discussion 1406-8
Casey WJ 3rd, Craft RO, Rebecca AM, Smith AA, Yoon S (2007) Intra-arterial tissue plasminogen activator: an effective adjunct following microsurgical venous thrombosis. Ann Plast Surg 59(5):520–525
Chang EI, Mehrara BJ, Festekjian JH, Da Lio AL, Crisera CA (2011) Vascular complications and microvascular free flap salvage: the role of thrombolytic agents. Microsurgery 31(7):505–509
Ihler F, Matthias C, Canis M (2013) Free flap salvage with subcutaneous injection of tissue plasminogen activator in head and neck patients. Microsurgery 33(6):478–481
Winterton RI, Pinder RM, Morritt AN, Knight SL, Batchelor AG, Liddington MI et al (2010) Long term study into surgical re-exploration of the ‘free flap in difficulty’. J Plast Reconstr Aesthet Surg 63(7):1080–1086
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For this retrospective study, formal consent from a local ethics committee is not required.
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Dariush Nikkhah, Ben Green, Stamatis Sapountzis, Onur Gilleard, Amanpreet Sidhu and Adam Blackburn declare that they have no conflict of interest.
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Patient provided written consent prior his inclusion in the study. Additional consent was obtained for the use of his images.
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Nikkhah, D., Green, B., Sapountzis, S. et al. Resurrection of an ALT flap with recombinant tissue plasminogen activator and heparin. Eur J Plast Surg 39, 221–224 (2016). https://doi.org/10.1007/s00238-015-1169-z
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DOI: https://doi.org/10.1007/s00238-015-1169-z