Free flap failure in an anticardiolipin antibody-positive patient with neoplasm--a case report.
We present herein a case of massive arterial thrombosis of a free rectus abdominal musculocutaneous flap used for reconstructive surgery of gingival carcinoma that could not be rescued. A 54-year-old woman underwent the operation. She had experienced two miscarriages in her 20s, but medical history was otherwise uneventful. Intraoperatively, the anastomosed artery often showed massive arterial thrombosis, and the flaps had become necrotic after bilateral flaps were used. Laboratory findings, 7 days postoperatively, showed high levels of immunoglobulin G anticardiolipin antibody. This value normalized by 2 months postoperatively after using chemotherapy. This case does not match the criteria for antiphospholipid syndrome, but some English-language reports have shown rising antiphospholipid antibody levels, particularly anticardiolipin antibodies, in patients with neoplasm. In those cases, levels have normalized after successful therapy. Antiphospholipid antibody levels should be examined before surgery to identify risks of hypercoagulability.
Asai
Emiko
E
Department of Plastic and Reconstructive surgery, Fukushima Medical University, Fukushima, Japan. smilingchild1025@yahoo.co.jp
Okouchi
Masayuki
M
Momiyama
Masanori
M
Kajikawa
Akiyoshi
A
Ueda
Kazuki
K
D017153:Antibodies, Anticardiolipin; D001157:Arterial Occlusive Diseases / Q000276:immunology*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000601:surgery*; D005260:Female; D005887:Gingival Neoplasms / Q000150:complications / Q000601:surgery*; D006801:Humans; D008334:Mandible / Q000601:surgery; D008875:Middle Aged; D037981:Neck Dissection; D019651:Plastic Surgery Procedures; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation; D012086:Reoperation; D013524:Surgical Flaps / Q000098:blood supply*; D019851:Thrombophilia / Q000276:immunology*; D013927:Thrombosis / Q000276:immunology
D017153:Antibodies, Anticardiolipin