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

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  • 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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Abstract

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.

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