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Background: Microvascular thrombosis following free tissue transfer presents a complex challenge for surgeons and carries the potential risk of flap failure. The application of fibrinolytic agents represents a robust therapeutic option. The aim of this systematic review is to provide a comprehensive overview of the clinical use of fibrinolytic drugs in the rescue of compromised free flaps., Methods: A systematic literature search for clinical studies detailing the utilization of fibrinolytic agents for salvaging free flaps was conducted using the PubMed and Web of Science databases. The inclusion criteria encompassed English-language publications that specifically addressed the clinical application of fibrinolytic agents for free-flap salvage., Results: A total of 331 articles were screened after excluding duplicates, with 56 meeting the inclusion criteria. Among these, 21 were clinical trials (evidence level III), and 35 were case studies (evidence level IV/V). In total, 459 flaps underwent treatment with fibrinolytic agents., Conclusion: The application of fibrinolytic agents appears to be a valuable intervention for rescuing compromised free flaps attributable to microvascular compromise. Notably, no prospective randomized trials have been published on this subject, and the evidence within the existing literature is characterized by its limited and heterogeneous nature. Further research is imperative to gather data on the efficacy, dosage, and safety profile of fibrinolytic agents.

Objectives: The anatomical distribution pattern of epidural intraspinal arteries is not entirely understood but is likely to substantially impact maintaining perfusion during segmental artery sacrifice when treating acute and chronic thoraco-abdominal aortic diseases. We investigated the anatomical distribution pattern of intraspinal arteries., Methods: Twenty fresh, non-embalmed cadaveric human bodies were studied. Anatomical dissection and investigation of the epidural arterial network were performed according to a standardized protocol. We used a generalized mixed linear model to test whether the presence probability for certain vessels differed between vertebrae/segments., Results: There was craniocaudal continuity of all ipsilateral longitudinal connections from T1 to L5 by the anterior radicular artery. The mean [±standard deviation (SD)] number of transverse anastomoses was 9.7 ± 2.1. The presence probability of transverse anastomoses along the spine was different between vertebrae (P < 0.0001). There were 2 distribution peaks along the spine: 1 peak around T4-T6 and 1 around T11. The mean (±SD) number of thoracic and lumbar anterior radiculomedullary arteries (ARMAs) was 3.0 ± 1.1. The probability of the presence of ARMAs along the spine was different for each vertebral segment (P < 0.0001). Between ARMAs there were gaps of up to a maximum of 9 vertebrae. All Adamkiewicz arteries were located caudally to T7. The median segment of the Adamkiewicz presence was T10/11., Conclusions: The epidural collateral network shows craniocaudal continuity. The number of transverse anastomoses is high. The number of ARMAs is low, and there is considerable variation in their distribution and offspring, which is highly likely to impact perfusion during segmental artery sacrifice when treating thoraco-abdominal aortic disease., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: Iatrogenic facial nerve injury is a common cause of long-standing facial palsy. This study aimed to assess functional results after facial reanimation in iatrogenic facial palsy and to determine correlating patient factors., Methods: The data of 128 iatrogenic facial palsy patients were analyzed for this case series. Inclusion criteria for assessment of facial function by three-dimensional video analysis were preoperative and postoperative (>18 months) video sets for facial marker tracking, which were available in 63 patients. Demographic factors and treatment concepts were analyzed and correlations to functional outcomes calculated., Results: One hundred and twenty-eight patients with iatrogenic facial palsy underwent facial reanimation procedures and were included in this study. The mean duration of facial palsy was 7.8 years. The most common procedures leading to iatrogenic facial palsy were acoustic neuroma resection (29.7%), parotidectomy (21.1%), and brainstem/cerebellopontine angle tumor resection (21.1%). Selected functional results were significantly improved after facial reanimation surgery. The mean lagophthalmos during eyelid closure reduced from 7.3 ± 4.1 mm to 5.4 ± 4 mm (p < .001). The function of the mouth was significantly improved, both statically (static asymmetry: 10.3 ± 7.6 mm preoperatively, 0.8 ± 9.5 mm postoperatively; p < .001), and during smile movement ("Dynamic Symmetry Index": 0.16 preoperatively, 0.39 postoperatively; p < .001). The mean duration of facial palsy correlated with postoperative smiling function (r = .358, p = .011)., Conclusion: Facial reanimation significantly improves facial function in iatrogenic facial palsy. Early referral to a facial nerve center is crucial as duration of facial palsy influences functional outcomes., (© 2019 Wiley Periodicals, Inc.)