Iloprost and salvage of a free flap

Despite the alluring pharmacological properties of prostacyclin and its stable analogue (iloprost), these substances are little used in plastic surgery. A case is presented in which iloprost resulted in persistent patency of the vessels supplying a free flap. A patient who had had failure of a free flap because of thrombosis distal to the arterial anastomosis had a second free flap. Thrombus formed distal to the arterial anastomosis of the second flap and recurred when the anastomosis was redone. The flap was perfused with urokinase and then iloprost. After this, iloprost was given intravenously peroperatively and for 12 hours postoperatively. Postoperatively, the patient also received aspirin, ticlopidine and heparin. The flap survived without any late complications. A literature review offers confirmation of the advantages of using iloprost if microvascular anastomoses thrombose and during the reperfusion of flaps after prolonged ischaemia.