Answer:
There have been sporadic cases reported of successful salvage of free flaps with no-reflow phenomenon using streptokinase and TPA, however, no randomized studies have been reported studying their overall efficacy. Reported dosages of streptokinase using a direct arterial infusion range from 7500 to 10000 units at a time given over 10 minutes. TPA has been reported to be given as a bolus of 400 mcg followed by an infusion rate of 800 mcg/hr for 1.5 hours then tapered off to 400 mcg for 2 hours and then 200 mcg for 1 hour. Any possible benefit must be balanced against the risk of hemorrhage.