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Thrombolysis in microvascular surgery using tissue-type plasminogen activator.

Abstract
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.
AuthorsJ E Romano, M A Biel
JournalArchives of otolaryngology--head & neck surgery (Arch Otolaryngol Head Neck Surg) Vol. 115 Issue 11 Pg. 1318-21 (Nov 1989) ISSN: 0886-4470 [Print] UNITED STATES
PMID2508729 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Tissue Plasminogen Activator
Topics
  • Animals
  • Blood Coagulation (drug effects)
  • Microsurgery (methods)
  • Rabbits
  • Surgical Flaps (methods)
  • Thrombolytic Therapy
  • Tissue Plasminogen Activator (pharmacology)
  • Vascular Patency
  • Vascular Surgical Procedures (methods)

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