Guidelines for Complications of Cancer Treatment Vol VIII Part B

- A flap with arterial blockade shows loss of tissue turgor,cold, blanched and on needle prick there is no flow ofblood.- Urgent re exploration and remedy of the cause of vascularcompromise can salvage the flap.- There is good correlation between time from detectionof thrombosis to re exploration and chances of survivalof flap i.e. the longer the time between thrombosis andre exploration the fewer the chances of successful salvageof flap.- If the flap does not have an external skin paddle formonitoring i.e. totally buried flap, an implantableDoppler can be used for monitoring.- At re exploration, venous thrombosis has greater chancesof successful salvage than arterial thrombosis.- When thrombosis is encountered at re exploration, clotevacuation is attempted by heparinized saline irrigationand gentle compression of flap.- If clot is adherent to vessel, thrombolytic therapy withstreptokinase/Urokinase or tissue plaminogen activatoris tried.- All patients with thrombosis where the flap is salvagedreceive systemic heparinization in the form of bolusheparin at the time of re exploration and followed postoperatively with heparin infusion. The target of therapyis to mention activated partial thromboplastin time2 – 2.5 times control value.- Subsequently after 3-5 days patients is switched over tooral warfarin therapy which is continued for a month.The target of warfarin therapy is to maintain the INRaround 2.- No reflow phenomenon is seen in cases where the reexploration was delayed. It refers to a condition where186