Local Application of Urokinase for Free Flap Salvage after Head and Neck Reconstruction: Analysis of 34 Cases

Background:Nowadays microsurgical free tissue transfer plays an important role in head and neck reconstruction, but the postoperative vascular thrombosis is still a nightmare for every microsurgeon. Despite the effort to avoid flap failure, sometimes we may still face the condition of the severe vascular thrombosis that cannot be easily resolved.Aim and Objectives:The aim of this study is to analyze the results of flap salvage after microvascular head and neck reconstruction, with the emphasis on using the thrombolytic agenturokinase.Material and Methods:From January 2009 to April 2011, 34 out of 345 cases having head and neck reconstruction with free flap transfer were re-explored due to postoperative vascular compromise. All cases were divided into 4 groups according to the presence of thrombi in the pedicle artery or vein, and the salvage results were further analyzed based on the use of urokinase or not.Result:Overall flap salvage rate was 85%, with 29 out of 34 free flaps successfully revascularized. Among the rescued flaps, only 4 flaps developed partial necrosis. In the group of venous thrombosis, most patients (11 out of 15) were treated with urokinase, and the salvage rate was up to 100%. In the arterial thrombosis group, 4 out of 5 were treated with Urokinase, and half of the flaps (2 out of 4) survived. None of the 18 cases, who received urokinase treatment, developed complications, such as hematoma, unstoppable bleeding, and intra-cranial hemorrhage.Conclusion:Our results demonstrated that intra-operative administration of thrombolytic agent did not increase the salvage rate of free flap. Proficient surgical technique, good operative design, precise judgment, and early detection of postoperative vascular compromise are the key factors of free flap success. The local application of urokinase intra-operatively can serve as a useful and safe adjunct upon vascular exploration for the thrombosis which was difficult to deal with. (J Taiwan Soc of Plast Surg 2011; 20; 288∼295)