A case of acute pulmonary thromboembolism after free flap reconstruction for tongue cancer

KITAMURA Naoya, ISHIDA Kousei, ITO Satoshi, DEGUCHI Hiroyo, HATA Tsuyoshi, HOSODA Masaru

doi:10.5794/jjoms.52.565

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Other Title

遊離皮弁による舌再建後に発症した急性肺血栓塞栓症の１例
ショウレイホウコクユウリヒベンニヨルシタサイケンゴニハッショウシタキュウセイハイケッセンソクセンショウノ 1レイ

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The incidence of pulmonary thromboembolism (PTE) has been increasing, although it remains lower in Japan than in Western countries. We report a case of PTE after free flap reconstruction in a patient with left tongue cancer (T2N2bM0) treated in May 2004.<BR>We performed tracheostomy, hemiglossectomy, and neck dissection. The tongue defect was repaired with a free radial forearm flap using a microsurgical vascular anastomosis. Although antithrombolytic therapy with prostaglandin El was started during microsurgery, circulatory disorders of the free flap occurred 2 days after operation. Therefore, we tried removing the intravenous thrombus and performed re-anastomosis, followed by anticoagulant and thrombolytic therapy. However, total necrosis of the flap occurred 5 days after re-operation. We therefore discontinued the anticoagulant and thrombolytic therapy. The following day PTE developed, but we saved the patient's life by immediate treatment, administered by cardiologists and other specialists.<BR>Our experience indicates that preventative treatment such as low-dose unfractionated heparin and using elastic stockings or intermittent pneumatic compression until the patient can walk after surgery may be necessary when there is a high risk of PTE.

Journal

Japanese Journal of Oral and Maxillofacial Surgery

Japanese Journal of Oral and Maxillofacial Surgery 52 (10), 565-568, 2006

Japanese Society of Oral and Maxillofacial Surgeons

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