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Use of streptokinase for the salvage of a free flap: Case report and review of the use of thrombolytic therapy

✍ Scribed by Warren Schubert; David W. Hunter; Gabriela Guzman-Stein; David H. Ahrenholz; Lynn D. Solem; Thomas D. Dressel; Dr. Bruce L. Cunningham

Publisher
John Wiley and Sons
Year
1987
Tongue
English
Weight
520 KB
Volume
8
Category
Article
ISSN
0738-1085

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✦ Synopsis

This is the first case report of the clinical use of intraoperative streptokinase to promote free flap salvage. A latissimus dorsi free flap was mobilized to cover a scalping type injury. After 4% hours of ischemia and recurrent thrombosis, streptokinase was perfused into the thoracodorsal artery (7,500 units of streptokinase in 30 cc of normal saline). The free flap was exposed to this concentration of streptokinase for 10 minutes followed by drainage of the venous effluent in order to avoid possible deleterious systemic effects of the streptokinase. Good flow throughout the free flap resulted, and the flap remained viable, providing good coverage for the patient's skull. Controversies regarding the no-reflow phenomena and the use of various thrornbolytic agents are discussed.

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