Head and Neck Reconstruction in Patients with Polycythemia Vera: Case Series and Literature Review

Sophia Dang, Leila J. Mady, Rahilla Tarfa, Jonathan C. Li, Frank Bontempo, Irina Chibisov, Mark W. Kubik, Mario G. Solari, Shaum Sridharan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background Polycythemia vera (PV) is a myeloproliferative disease with overproduction of erythrocytes, leukocytes, and platelets causing an increased risk of both thrombosis and hemorrhage. There are limited reports and no established guidelines for managing such patients undergoing reconstructive surgery. Methods We present four patients with PV and head and neck cancer who required reconstruction after resection and provide a review of the current literature. Results Preoperatively, patients on cytoreductive therapy continued with their treatment throughout their hospital course and had hematologic parameters normalized with phlebotomy or transfusions if needed. Two patients who underwent free flap surgery (cases 1 and 2) had postoperative courses complicated by hematoma formation and persistent anemia, requiring multiple transfusions. Cases 3 and 4 (JAK2+ PV and JAK2- PV, respectively) underwent locoregional flap without postoperative complications. Conclusion Concomitant presentation of PV and head and neck cancer is uncommon and presents unique challenges for the reconstructive surgeon. Overall, we recommend that patients should have hematologic parameters optimized prior to surgery, continue ruxolitinib or hydroxyurea, and hold antiplatelet/anticoagulation per established department protocols. It is essential to engage a multidisciplinary team involving hematology, head and neck and reconstructive surgery, anesthesia, and critical care to develop a standardized approach for managing this unique subset of patients.

Original languageEnglish
Pages (from-to)67-74
Number of pages8
JournalJournal of Hand and Microsurgery
Volume15
Issue number1
DOIs
StatePublished - 7 Feb 2023
Externally publishedYes

Keywords

  • head and neck cancer
  • head and neck surgery
  • hydroxyurea
  • microvascular free flap
  • microvascular surgery
  • plastic surgery
  • polycythemia vera
  • reconstruction
  • reconstructive surgery
  • ruxolitinib

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