Local intravenous thrombolysis with recombinant tissue plasminogen activator for salvage of forearm replantation.

Microvascular anastomoses are at risk of thrombosis, especially when repairing avulsed or crushed tissues, or when ischemia time is prolonged. When all surgical techniques to avoid thrombosis of the microanastomoses fail, thrombolytic agents may play a role in dissolving the thrombus and preventing rethrombosis. The authors present a case in which recombinant tissue plasminogen activator (rt-PA) was locally infused to salvage thrombosed venous microanastomoses after replantation of an amputated forearm. They also review the effects of different thrombolytic agents, and emphasize the benefits of rt-PA and its promising role in microsurgery.