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November 1989

Thrombolysis in Microvascular Surgery Using Tissue-Type Plasminogen Activator

Author Affiliations

From the Departments of Otolaryngology, University of Minnesota, Minneapolis, the Veterans Administration Medical Center, Minneapolis, and the Minneapolis Ear, Nose, and Throat Research Foundation.

Arch Otolaryngol Head Neck Surg. 1989;115(11):1318-1321. doi:10.1001/archotol.1989.01860350052014

• Thrombosis at the microanastomotic site is the primary cause of free flap failure. Tissue-type plasminogen activator, a potent thrombolytic agent, effectively lyses vessel thromboses. This study examined the efficacy of tissue-type plasminogen activator in a microvascular model using a modified vascular inversion graft in rabbits. Seventeen rabbits underwent this procedure with formation of thromboses in all but one inversion graft. Ten rabbits were locally infused with 1 mg of tissue-type plasminogen activator over a period of 4 hours; 6 control rabbits received normal saline infusions. Blood flow across the graft was reestablished in all 10 rabbits receiving tissue-type plasminogen activator and in none of those with normal saline infusions. Systemic fibrinolysis was not significantly altered. We conclude that local infusion of tissue-type plasminogen activator is effective in lysing thromboses that may occur at the venous microvascular anastomotic site without significant activation of systemic fibrinolysis.

(Arch Otolaryngol Head Neck Surg. 1989;115:1318-1321)

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