26.05.25

Free flap microvascular surgery and managing thrombotic complications with Alteplase

AJOMS Volume 2 | Issue 1 · May 2025 | 41

ABSTRACT

This case report describes the successful intraoperative

management of a fibula free flap, which demonstrated the noreflow

phenomenon, using locally administered alteplase in an

otherwise well 17-year-old male patient with a right mandibular

odontogenic myxoma.

Microvascular free flap reconstruction is considered the gold

standard for the management of many head and neck surgical

defects. The vitality of the flap is reliant on the perfusion of the

reconstructed tissue with vascular anastomoses to the recipient

site. Alteplase is a fibrinolytic drug normally indicated for use in

thrombotic events.

There are very few case reports in the literature to support the

use of fibrinolytic agents in microvascular flap surgery, and

alteplase may provide an option for intraoperative flap salvage

when all other avenues have been exhausted.