Pharmacologic partial salvage of a failing free flap with recombinant tissue plasminogen activator (rt-PA)

Despite ail the technical improvements in microvascular surgery and the exp erience gained in clinical practice, thrombosis at the site of microanastom osis remains a significant problem and a continuous source of frustration t o most microsurgeons. Early recognition of vascular complications and promp t reexploration with vascular revision remain an essential and standard con duct for salvage. However, in situations where conditions for no-reflow hav e been established due to severe vasospasm or prolonged ischemia time, it b ecomes obvious that surgical reexploration alone is not enough to salvage a failing flap or a replanted limb. In such situations, the loss of the reva scularized tissues seems to be inevitable. The authors describe their experience in partially salvaging a failing free flap with recombinant tissue plasminogen activator (rt-PA), reversing an e stablished state of no-reflow. Pharmacologic manipulation of the complex an d Variable factors influencing anastomotic patency in microvascular tissue transfer seems to offer a new hope for preventing failures, as well as for salvaging failing flaps. It appears also that free-tissue transfer failure is not an all-or-none phenomenon.