PMC7522445_01
Free flap salvage algorithm.
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After surgery the flap was monitored every 2 h by visual inspection according to our monitoring scheme (Fig. 1). As recommended in our flap salvage algorithm (Fig. 1) the patient was taken back to the operation room within an hour for exploration of the anastomotic vessels.
Free flap salvage operation.. (A) Intra-arterial vessel catheterization of 2 mg Alteplase (1) into the radial artery (2). (B) Flap (*) during salvage operation directly after thrombolysis. The bluish skin color declines and rosy skin coloring returns.
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Now Alteplase (Actilyse , 2 mg) was injected directly into the arterial pedicle over a period of 10 min (Fig. 2A). At the end of the procedure the flap showed a rosier coloration, reduced turgor and bright capillary bleeding (Fig. 2B).
Postoperative aspect.. (A) 8 days after revision surgery the flap (*) developed a dehiscence (double arrow) at the cranial part and a partial superficial necrosis at the lateral edge (1). (B) 28 months after revision surgery the flap (*) is completely integrated into the mucosa of the left oropharynx.
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The deep layers of the dermis survived (Fig. 3A). The flap resisted 6 weeks of adjuvant chemoradiotherapy (Cisplatin, radiation dose 64 Gy) and is completely incorporated into the mucosa (Fig. 3B).