Eptifibatide Salvage of Arterial Anastomotic Thrombosis in Lower Extremity Free Flap Reconstruction: A Case Report

Free flap reconstruction conforms to three-dimensional wounds and has an important role in complex soft tissue defects in lower extremities.[1] Yazar et al showed complete flap survival rates of ± 93% in free muscle flap reconstructions of distal third open tibial fractures; some debate remains about indications for free muscle versus free fasciocutaneous flaps.[2] The most common cause for reexploration and microvascular failure is perianastomotic thrombosis, with arterial thrombosis less common than venous thrombosis.[3] Urokinase and alteplase are therapeutic options that have been used to successfully salvage free flap reconstruction.[4]

Eptifibatide (Integrilin, Millennium Pharmaceuticals, Cambridge, MA) is a drug of the glycoprotein IIb/IIIa-inhibitor class. We present a case of successful salvage with a partial superior latissimus dorsi free muscle flap in a patient with thrombocytosis and intraoperative arterial anastomotic thrombosis using intra- and postoperative administration of eptifibatide combined with heparin infusion.

• References

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