One of the major complications of a free flap transfer is thrombosis. We present a case in which free flap thrombosis was salvaged by intra-arterial injection of recombinant tissue plasminogen activator (rt-PA).
A 50-year-old man visited our hospital with the chief complaint of a progressively enlarging oral mass. We diagnosed the patient as having cancer of the hard palate, cT4aN2cM0, and performed radical surgery using a rectus abdominis myocutaneous flap. The flap became congested 27 hours after the operation, and we immediately decided to perform another operation. During the salvage surgery, we noted thrombosis in the flap at the site of the venous anastomosis and performed thrombectomy as thoroughly as possible. Because venous return from the flap remained weak even after thrombectomy, we suspected persistence of thrombosis within the flap. We tried injecting rt-PA into the flap artery in order to lyse the thrombosis. The venous return increased by 1 hour after this injection, and the color of the flap also improved. We completed the operation after anastomosing the veins. The color of the flap gradually turned positive (skin color) after the operation and the flap completely survived.
In conclusion, intra-arterial rt-PA injection may be safe and effective treatment for free flap thrombosis.
