Abstract
Hemophilia is a blood disorder characterized by impairment of the coagulation cascade leading to an increased bleeding risk (Kauffman, 2014). As such, surgical management of these patients can become difficult and well-defined surgical guidelines are not yet in place (Assoumane et al., 2017). Close monitoring of perioperative factor levels may be even more crucial for those undergoing microvascular free tissue transfer. This is because either a hypercoagulable or hypocoagulable bleeding state has the potential to further increase the risk of vascular compromise to the flap. We report a successful case of mandibular reconstruction using a free fibular flap in a patient with severe hemophilia B and the protocols we used, as well as a review of the literature of similar cases. In the literature, we identified 6 cases of microvascular free tissue transfer in patients with hemophilia; two of these cases had complications which were both related to excess bleeding. It is crucial that these cases be managed in a multidisciplinary fashion in close consultation with a hematologist. The role of venothromboembolism (VTE) prophylaxis in the hemophilic patient undergoing free tissue transfer is discussed.
Highlights
Hemophilia is the second most common inherited bleeding disorder behind Von Willebrand’s disease
The International Society of Thrombosis and Hemostasis grades the severity of hemophilia based on the concentration of circulating coagulation factors: 5-40% of normal is considered mild, 1-5% is moderate, and less than 1% is severe [2]
We present a case report of a patient with severe hemophilia B who successfully underwent free fibular flap
Summary
Hemophilia is the second most common inherited bleeding disorder behind Von Willebrand’s disease. There are two main forms of hemophilia: hemophilia A (1/5,000 male live births) is a deficiency of factor VIII and hemophilia B (1/25,000 male live births) is a deficiency of factor IX [1] Both forms of the disease are clinically indistinguishable and lead to an impairment of the coagulation cascade causing an increased tendency to bleed. Altered hemodynamics may compromise the blood flow and flap survival rate; strict protocols for microvascular surgery may be even more crucial. It is unclear whether these procedures can be performed safely in the severe hemophilic patient due to the lack of data regarding this topic. The aim of this report is to contribute to the body of literature regarding the safety of microvascular free flap reconstruction in hemophiliacs with the hope of generating more predictive protocols
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