{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T07:00:52Z","timestamp":1768460452222,"version":"3.49.0"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2008,3,11]],"date-time":"2008-03-11T00:00:00Z","timestamp":1205193600000},"content-version":"vor","delay-in-days":70,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2008,1]]},"abstract":"Abstract<\/jats:title>Introduction:<\/jats:italic> Despite high success rates with free\u2010tissue transfer, flap loss continues to be a devastating event. Flap salvage is often successful if vascular complications are recognized and treated early. However, delayed presentation of flap compromise is an ominous predictor of flap loss. Late free\u2010flap salvage has been described with poor long\u2010term results. Catheter\u2010directed thrombolysis (CDT) has only been described in context with free\u2010tissue transfer in a case of distal bypass salvage. Objectives:<\/jats:italic> The authors examined the efficacy of highly selective CDT in late salvage of free\u2010flaps with vascular compromise. Methods:<\/jats:italic> Two patients underwent highly selective CDT after delayed presentation (>5 days) of flap compromise. Patient 1 is a 59\u2010year\u2010old woman who underwent delayed breast reconstruction with a free TRAM flap and presented with arterial thrombosis 12 days postoperatively. Patient 2 is a 53\u2010year\u2010old man who underwent fibular osteocutaneous free\u2010flap reconstruction of a floor of mouth defect who developed venous thrombosis 6 days postoperatively. Patient 2 underwent two attempted operative anastamotic revisions with thrombectomies and local thrombolysis prior to CDT. Results:<\/jats:italic> The average time of presentation was 9 days, with the average time to CDT being 9.5 days. Patient 1 had an arterial thrombosis, whereas Patient 2 had a venous thrombosis. Both patients underwent successful thrombolysis after super\u2010selective angiograms. Continuous infusions of thrombolytic agents were used in both patients for \u223c24 h. Average length of stay postCDT was 7 days with no perioperative complications. Long\u2010term follow\u2010up demonstrated complete flap salvage with no soft tissue loss. Conclusion:<\/jats:italic> Despite extremely delayed presentation, aggressive CDT was successful in both breast, and head and neck reconstructions with excellent long\u2010term flap results. CDT appears to be a useful modality in managing difficult cases of free\u2010flap salvage. \u00a9 2008 Wiley\u2010Liss, Inc. Microsurgery, 2008.<\/jats:p>","DOI":"10.1002\/micr.20480","type":"journal-article","created":{"date-parts":[[2008,3,11]],"date-time":"2008-03-11T16:24:21Z","timestamp":1205252661000},"page":"217-222","source":"Crossref","is-referenced-by-count":33,"title":["Late free\u2010flap salvage with catheter\u2010directed thrombolysis"],"prefix":"10.1002","volume":"28","author":[{"given":"Andrew P.","family":"Trussler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James P.","family":"Watson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher A.","family":"Crisera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2008,3,11]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199009000-00019"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199612000-00017"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-199604000-00006"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198908000-00015"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199207000-00014"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199302000-00020"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/micr.20147"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0007-1226(02)00480-0"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/micr.1920140911"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1006872"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1989.01860350052014"},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199811000-00021"},{"key":"e_1_2_1_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-200106000-00005"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-815638"},{"key":"e_1_2_1_16_2","doi-asserted-by":"publisher","DOI":"10.1054\/bjps.2002.3744"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fmicr.20480","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.20480","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T23:06:29Z","timestamp":1700003189000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.20480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,1]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2008,1]]}},"alternative-id":["10.1002\/micr.20480"],"URL":"https:\/\/doi.org\/10.1002\/micr.20480","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,1]]}}}