Microvascular free flap in a pregnant patient after resection of a high-grade neuroendocrine carcinoma
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.
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References
- Haws MJ, Erdmann D, Brown RE. Above-elbow arm replantation during pregnancy. Ann Plast Surg 1996; 36: 93–6. doi: 10.1097/00000637-199601000-00019
- Lloyd CJ, Paley MD, Penfold CN, Varadarajan V, Tehan B, Gollins SW. Microvascular free tissue transfer in the management of squamous cell carcinoma of the tongue during pregnancy. Br J Oral Maxillofac Surg 2003; 41(2): 109–11. doi: 10.1016/S0266-4356(03)00003-2
- Al Qattan MM, Bowen V. Effect of pre-existing health conditions on the results of reconstructive microsurgery. Microsurgery 1993; 14: 152–7. doi: 10.1002/micr.1920140304
- Meger GR, Majewski WT, Lyle WG. Free tissue transfer in pregnancy: guidelines for perioperative management. Microsurgery 2001; 21(5): 202–7. doi: 10.1002/micr.1039. PMID: 11494393
- Cordeiro PG, Chen CM. A 15-year review of midface reconstruction after total and subtotal maxillectomy: part I. Algorithm and outcomes. Plast Reconstr Surg 2012; 129(1): 124–36. doi: 10.1097/PRS.0b013e318221dca4
- Torabi SJ, Cheraghlou S, Kasle DA, Savoca EL, Judson BL. Nonsquamous cell laryngeal cancers: incidence, demographics, care patterns, and effect of surgery. Laryngoscope 2019; 129(11): 2496–505. doi: 10.1002/lary.27785
- Van der Laan TP, Plaat BE, van der Laan BF, Halmos GB. Clinical recommendations on the treatment of neuroendocrine carcinoma of the larynx: a meta-analysis of 436 reported cases. Head Neck 2015; 37: 707–15. doi: 10.1002/hed.23666
- Antonelli NM, Dotters DJ, Katz VL, Kuller JA. Cancer in pregnancy: a review of the literature. Part I. Obstet Gynecol Surv 1996; 51: 125–34. doi: 10.1097/00006254-199602000-00022
- Miyazaki Y, Fukuda K, Fujita K, Nishimoto S, Terada T, Wada R, et al. Free flap transfer reconstruction in managing tongue carcinoma during pregnancy. J Surg Case Rep 2017; 2017(8): 1–4. doi: 10.1093/jscr/rjx164
- Po G, Olivieri C, Rose CH, Saccone G, McCurdy R, Berghella V. Intraoperative fetal heart monitoring for non-obstetric surgery: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019; 238: 12–19. doi: 10.1016/j.ejogrb.2019.04.033
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