ILOPROST AND SALVAGE OF A FREE-FLAP

Despite the alluring pharmacological properties of prostacyclin and it s stable analogue (iloprost), these substances are little used in plas tic surgery. A case is presented in which iloprost resulted in persist ent patency of the vessels supplying a free flap. A patient who had ha d failure of a free flap because of thrombosis distal to the arterial anastomosis had a second free flap. Thrombus formed distal to the arte rial anastomosis of the second flap and recurred when the anastomosis was redone. The flap was perfused with urokinase and then iloprost. Af ter this, iloprost was given intravenously peroperatively and for 12 h ours postoperatively. Postoperatively, the patient also received aspir in, ticlopidine and heparin. The flap survived without any late compli cations. A literature review offers confirmation of the advantages of using iloprost if microvascular anastomoses thrombose and during the r eperfusion of flaps after prolonged ischaemia.