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Mandal P, Moshammer M, Hecker A, Smolle C, Carnieletto M, Mayrhofer M, Schintler M, Winter R, Kamolz LP. The Use of Fibrinolytic Agents in the Salvage of Free Flaps: A Systematic Review. J Pers Med 2024; 14:800. [PMID: 39201992 PMCID: PMC11355706 DOI: 10.3390/jpm14080800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Microvascular thrombosis following free tissue transfer presents a complex challenge for surgeons and carries the potential risk of flap failure. The application of fibrinolytic agents represents a robust therapeutic option. The aim of this systematic review is to provide a comprehensive overview of the clinical use of fibrinolytic drugs in the rescue of compromised free flaps. METHODS A systematic literature search for clinical studies detailing the utilization of fibrinolytic agents for salvaging free flaps was conducted using the PubMed and Web of Science databases. The inclusion criteria encompassed English-language publications that specifically addressed the clinical application of fibrinolytic agents for free-flap salvage. RESULTS A total of 331 articles were screened after excluding duplicates, with 56 meeting the inclusion criteria. Among these, 21 were clinical trials (evidence level III), and 35 were case studies (evidence level IV/V). In total, 459 flaps underwent treatment with fibrinolytic agents. CONCLUSION The application of fibrinolytic agents appears to be a valuable intervention for rescuing compromised free flaps attributable to microvascular compromise. Notably, no prospective randomized trials have been published on this subject, and the evidence within the existing literature is characterized by its limited and heterogeneous nature. Further research is imperative to gather data on the efficacy, dosage, and safety profile of fibrinolytic agents.
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Affiliation(s)
- Patrick Mandal
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 34/4, 8010 Graz, Austria; (M.M.); (C.S.); (M.C.); (M.M.); (M.S.); (R.W.); (L.P.K.)
| | - Maximilian Moshammer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 34/4, 8010 Graz, Austria; (M.M.); (C.S.); (M.C.); (M.M.); (M.S.); (R.W.); (L.P.K.)
- COREMED—Centre for Regenerative Medicine and Precisions Medicine, Neue Stiftingtalstrasse 2, 8010 Graz, Austria
| | - Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 34/4, 8010 Graz, Austria; (M.M.); (C.S.); (M.C.); (M.M.); (M.S.); (R.W.); (L.P.K.)
- COREMED—Centre for Regenerative Medicine and Precisions Medicine, Neue Stiftingtalstrasse 2, 8010 Graz, Austria
| | - Christian Smolle
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 34/4, 8010 Graz, Austria; (M.M.); (C.S.); (M.C.); (M.M.); (M.S.); (R.W.); (L.P.K.)
| | - Martina Carnieletto
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 34/4, 8010 Graz, Austria; (M.M.); (C.S.); (M.C.); (M.M.); (M.S.); (R.W.); (L.P.K.)
| | - Marcel Mayrhofer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 34/4, 8010 Graz, Austria; (M.M.); (C.S.); (M.C.); (M.M.); (M.S.); (R.W.); (L.P.K.)
| | - Michael Schintler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 34/4, 8010 Graz, Austria; (M.M.); (C.S.); (M.C.); (M.M.); (M.S.); (R.W.); (L.P.K.)
| | - Raimund Winter
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 34/4, 8010 Graz, Austria; (M.M.); (C.S.); (M.C.); (M.M.); (M.S.); (R.W.); (L.P.K.)
| | - Lars Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 34/4, 8010 Graz, Austria; (M.M.); (C.S.); (M.C.); (M.M.); (M.S.); (R.W.); (L.P.K.)
- COREMED—Centre for Regenerative Medicine and Precisions Medicine, Neue Stiftingtalstrasse 2, 8010 Graz, Austria
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Marlborough F, Berner JE, Ahmed OA, Ragbir M. Comment on Assessing the Influence of Attending Surgeon Continuity on Free Flap Outcomes Following Unplanned Returns to the Operating Room. J Reconstr Microsurg 2020; 36:e1-e2. [PMID: 33231271 DOI: 10.1055/s-0040-1721121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Fergal Marlborough
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Juan Enrique Berner
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Omar A Ahmed
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Maniram Ragbir
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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