Abstract
Free flap reconstruction is seldom performed during pregnancy. Not only does the prolonged operative time pose a risk for the mother and the fetus, but also the hypercoagulable state of pregnancy predisposes the mother to a greater risk of complications in the transplanted tissue. We present a case of a 29-year-old patient in week 27 of gestation with a rapidly progressive neuroendocrine tumor in the left nasal fossa with involvement of the nasal sinus, pterygopalatine fossa, dura, and left orbit, associated with neurological symptoms and recurrent epistaxis. The aggressive and rapidly progressive character of the tumor made surgical excision by a multidisciplinary team as the first option. We performed immediate reconstruction with an anterolateral thigh free flap. Free tissue transfer was performed successfully, with satisfactory results on the mother and later delivery without complications.
Highlights
Free flap reconstruction is seldom performed during pregnancy
Lloyd et al in 2003 described the case of a 36-year-old patient in her third trimester of pregnancy with a grade III tongue carcinoma treated with excision and reconstruction with a radial forearm free flap; this being the first reported case of a successful microvascular transfer in oral cancer during pregnancy (2)
As in the case of reconstruction after resection of aggressive head and neck tumors, the second trimester of gestation is considered the safest time for anesthetic procedures, when organogenesis is complete, and the risk of preterm labor is low (4)
Summary
Free flap reconstruction is seldom performed during pregnancy. does the prolonged operative time pose a risk for the mother and the fetus, and the hypercoagulable state of pregnancy predisposes the mother to a greater risk of complications in the transplanted tissue. We present a case of a 29-year-old patient in week 27 of gestation with a rapidly progressive neuroendocrine tumor in the left nasal fossa with involvement of the nasal sinus, pterygopalatine fossa, dura, and left orbit, associated with neurological symptoms and recurrent epistaxis. Lloyd et al in 2003 described the case of a 36-year-old patient in her third trimester of pregnancy with a grade III tongue carcinoma treated with excision and reconstruction with a radial forearm free flap; this being the first reported case of a successful microvascular transfer in oral cancer during pregnancy (2). Only few cases of microvascular flaps during pregnancy have been reported, most of them associated with reconstruction following the resection of head and neck tumors. A case of successful microvascular transfer following resection of a high-grade neuroendocrine head and neck tumor during pregnancy is presented.
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