Abstract
Venous insufficiency is a severe complication of microvascular free tissue transfers, which may ultimately cause free flap failure. In this report, we describe a case of microvascular free flap reconstruction after oral cancer resection, complicated with venous thromboembolism manifested as venous insufficiency of the flap and pulmonary embolism (PE). Antithrombin III deficiency related heparin resistance was found during the course of treatment. With flap reexploration, veno-venous extracorporeal membrane oxygenation (V-V ECMO) and systemic anticoagulation therapy with a direct oral anticoagulant (DOAC), the flap was successfully salvaged and the patient recovered well.
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