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Updated: Jul 28, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Local recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy in microvascular surgery
B S Atiyeh1, H A Hashim, A M Hamdan
1Division of Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Microsurgery
|September 1, 1999
Summary
Local recombinant tissue plasminogen activator (rt-PA) effectively treats vascular thrombosis in microsurgery. This approach minimizes systemic side effects, improving outcomes in limb replantation and tissue transfer procedures.
Area of Science:
- Vascular Surgery
- Regenerative Medicine
- Thrombosis Management
Background:
- Vascular thrombosis is a major complication in microsurgery, leading to graft failure despite advancements.
- Current anticoagulation and antiplatelet protocols have limitations, and systemic thrombolytics pose bleeding risks.
Observation:
- This study explores the use of local recombinant tissue plasminogen activator (rt-PA) via intra-arterial, intravenous, and soft-tissue injection in replantation surgery.
- Specific administration routes were employed for arterial thrombi (intra-arterial infusion), venous thrombi (intravenous infusion), and digital replants (soft-tissue injection).
Findings:
- Local rt-PA administration demonstrated success in managing arterial and venous thrombi in replantation cases.
- Soft-tissue injection of rt-PA proved effective for salvaging replanted digits where direct vascular infusion was not feasible.
Implications:
- Local rt-PA offers a targeted approach to thrombolysis in microsurgery, reducing systemic complications.
- This method holds promise for preventing and salvaging free flap failures in composite tissue transfer procedures.
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