Salvage of free-flaps in vessel-depleted mandibular osteoradionecrosis cases using catheter-directed thrombolysis and angioplasty.

Abstract

OBJECTIVES:

To evaluate the efficacy of highly selective catheter-directed thrombolysis (CDT) and angioplasty for salvage of compromised free flaps that were performed for treatment of mandibular osteoradionecrosis (ORN).

DESIGN:

Case series

SETTING:

University of California, Los Angeles (UCLA) Medical Center

PATIENTS:

Two patients with ORN who underwent highly selective CDT to salvage threatened free flaps are reported. One patient experienced arterial thrombosis on postoperative day 8 and underwent arterial CDT and angioplasty. A second patient underwent central venous CDT for a subclavian vein thrombosis that was diagnosed during the immediate postoperative period.Interventions Highly selective CDT and angioplasty for salvage of compromised free flaps

MAIN OUTCOMES MEASURED:

Flap survival, patient survival, hemorrhagic complications.

RESULTS:

Both patients underwent successful thrombolysis. One patient required two CDT procedures over a 48-hour period; the other patient received continuous CDT infusion of tissue plasminogen activator (TPA) for 24 hours. There were no procedure-related complications. Long-term follow-up demonstrated complete flap survival with no flap necrosis.

CONCLUSION:

Free flaps performed for mandibular ORN have increased complication rates, and the surgical options for salvage of flap ischemia are often limited in patients with a heavily radiated, vessel-depleted neck. Aggressive CDT and angioplasty appears to be a useful modality in managing difficult cases of free-flap salvage in patients with mandibular ORN.

• Authors: Matthew Tamplen, Keith Blackwell, Reza Jahan, Vishad Nabili
• Journal: Journal of reconstructive microsurgery (J Reconstr Microsurg) Vol. 29 Issue 5 Pg. 347-52 (Jun 2013) ISSN: 1098-8947 [Electronic] United States
• PMID: 23580423 (Publication Type: Case Reports, Journal Article)
• Copyright: Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Topics

• Aged, 80 and over
• Angiography
• Angioplasty
• Female
• Free Tissue Flaps (blood supply)
• Head and Neck Neoplasms (surgery)
• Humans
• Male
• Mandibular Diseases (surgery)
• Middle Aged
• Osteoradionecrosis (surgery)
• Postoperative Complications (therapy)
• Plastic Surgery Procedures
• Salvage Therapy
• Thrombolytic Therapy (methods)
• Thrombosis (therapy)
• Ultrasonography, Doppler