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J Hand Microsurg 2023; 15(01): 067-074
DOI: 10.1055/s-0041-1734398
Original Article

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

Sophia Dang
1   Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Leila J. Mady
2   Department of Otorhinolaryngology Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Rahilla Tarfa
3   University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
,
Jonathan C. Li
4   Combined Internal Medicine–Pediatrics Residency Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Frank Bontempo
5   Department of Internal Medicine, The Institute of Transfusion Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Irina Chibisov
5   Department of Internal Medicine, The Institute of Transfusion Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Mark W. Kubik
1   Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
6   Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Mario G. Solari
1   Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
6   Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Shaum Sridharan
1   Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
6   Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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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.

Keywords

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


Publication History

Article published online:
15 September 2021

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