Morbidity and economic complications following mucogingival surgery in a hemophiliac HIV-infected patient: a case report.
BACKGROUND
This report describes the surgical treatment of a gingival recession in a hemophiliac HIV-infected patient. To our knowledge, mucogingival surgery has not been described previously in these patients.


METHODS
Under the supervision of the patient's hematologist, a subepithelial connective tissue graft procedure was carried out to treat the recession. The treatment was performed after substitution therapy with factor VIII concentrate, supported by local antifibrinolytic treatment with epsilonaminocaproic acid.


RESULTS
One week after surgery, the grafted zone showed a normal healing, but an area of necrosis appeared at the donor palatal site with spontaneous bleeding. The administration of factor VIII concentrate had to be prolonged to arrest the hemorrhage. In total, 44,500 units of factor VIII concentrate were used, the cost of which reached around $20,000. After 1 month the donor site had re-epithelialized by secondary intention. The root coverage was around 85% successful.


CONCLUSIONS
Because of the surgical risk and the high economic cost in the use of the factor VIII concentrate, we do not recommend performing mucogingival surgery in HIV-infected hemophiliacs unless it is absolutely necessary. Prevention and early treatment must be the goal in the management of these patients.
Blanco-Carrion
Juan
J
School of Medicine and Dentistry, University of Santiago de Compostela, Spain.
Liñares-Gonzalez
Antonio
A
Batalla-Vazquez
Pilar
P
Diz-Dios
Pedro
P
D000328:Adult; D015119:Aminocaproic Acid / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D003029:Coagulants / Q000191:economics / Q000627:therapeutic use; D003238:Connective Tissue / Q000637:transplantation; D016527:Drug Costs; D005169:Factor VIII / Q000191:economics / Q000627:therapeutic use; D005881:Gingiva / Q000637:transplantation; D005889:Gingival Recession / Q000191:economics / Q000601:surgery*; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications*; D006467:Hemophilia A / Q000150:complications* / Q000191:economics; D006801:Humans; D008297:Male; D009336:Necrosis; D006472:Oral Hemorrhage / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology
D000933:Antifibrinolytic Agents; D003029:Coagulants; D005169:Factor VIII; D015119:Aminocaproic Acid