TY - JOUR
T1 - Head and Neck Reconstruction in Patients with Polycythemia Vera
T2 - Case Series and Literature Review
AU - Dang, Sophia
AU - Mady, Leila J.
AU - Tarfa, Rahilla
AU - Li, Jonathan C.
AU - Bontempo, Frank
AU - Chibisov, Irina
AU - Kubik, Mark W.
AU - Solari, Mario G.
AU - Sridharan, Shaum
N1 - Publisher Copyright:
© 2020. Society of Indian Hand Surgery &Microsurgeons. All rights reserved..
PY - 2023/2/7
Y1 - 2023/2/7
N2 - 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.
AB - 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.
KW - head and neck cancer
KW - head and neck surgery
KW - hydroxyurea
KW - microvascular free flap
KW - microvascular surgery
KW - plastic surgery
KW - polycythemia vera
KW - reconstruction
KW - reconstructive surgery
KW - ruxolitinib
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UR - http://www.scopus.com/inward/citedby.url?scp=85115384652&partnerID=8YFLogxK
U2 - 10.1055/s-0041-1734398
DO - 10.1055/s-0041-1734398
M3 - Article
C2 - 36761055
AN - SCOPUS:85115384652
SN - 0974-3227
VL - 15
SP - 67
EP - 74
JO - Journal of Hand and Microsurgery
JF - Journal of Hand and Microsurgery
IS - 1
ER -