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

doi:10.1055/s-0041-1734398

Journal of Hand and Microsurgery, Inhaltsverzeichnis

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

¹Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

,

Leila J. Mady

²Department of Otorhinolaryngology Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Rahilla Tarfa

³University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

,

Jonathan C. Li

⁴Combined Internal Medicine–Pediatrics Residency Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

,

Frank Bontempo

⁵Department of Internal Medicine, The Institute of Transfusion Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

,

Irina Chibisov

⁵Department of Internal Medicine, The Institute of Transfusion Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

,

Mark W. Kubik

¹Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

⁶Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

,

Mario G. Solari

¹Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

⁶Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

,

Shaum Sridharan

¹Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

⁶Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

› Institutsangaben

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

Volltext

Referenzen

References
1 Briere PJ. Secondary polycythemia. In: Orphanet Ency-clopedia. Last accessed in December 2020 at: https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=98428
2 Cuthbert D, Stein BL. Polycythemia vera-associated complications: pathogenesis, clinical manifestations, and effects on outcomes. J Blood Med 2019; 10: 359-371
3 Tefferi A, Rumi E, Finazzi G. et al. Survival and prognosis among 1545 patients with contemporary polycythemia vera: an international study. Leukemia 2013; 27 (09) 1874-1881
4 Lin SJ, Yu P. Free tissue transfer in a head and neck cancer patient with polycythemia vera. Plast Reconstr Surg 2009; 124 (01) 169e-170e
5 Ghazali N, Collyer JC, Tighe JV. Hemimandibulectomy and vascularized fibula flap in bisphosphonate-induced mandibular osteonecrosis with polycythaemia rubra vera. Int J Oral Maxillofac Surg 2013; 42 (01) 120-123
6 Griesshammer M, Kiladjian J-J, Besses C. Thromboembolic events in polycythemia vera. Ann Hematol 2019; 98 (05) 1071-1082
7 Barbui T, Tefferi A, Vannucchi AM. et al. Philadelphia chromosome-negative classical myeloproliferative neoplasms: revised management recommendations from European LeukemiaNet. Leukemia 2018; 32 (05) 1057-1069
8 Mesa RA, Jamieson C, Bhatia R. et al. NCCN Guidelines Insights: Myeloproliferative Neoplasms, Version 2.2018. J Natl Compr Canc Netw 2017; 15 (10) 1193-1207
9 Marchioli R, Finazzi G, Specchia G. et al. CYTO-PV Collaborative Group. Cardiovascular events and intensity of treatment in polycythemia vera. N Engl J Med 2013; 368 (01) 22-33
10 Mirzabeigi MN, Wang T, Kovach SJ, Taylor JA, Serletti JM, Wu LC. Free flap take-back following postoperative microvascular compromise: predicting salvage versus failure. Plast Reconstr Surg 2012; 130 (03) 579-589
11 Cho EH, Bauder AR, Centkowski S. et al. Preoperative platelet count predicts lower extremity free flap thrombosis: a multi-institutional experience. Plast Reconstr Surg 2017; 139 (01) 220-230
12 Tarabishy SP, Inglesby D, Tapp M, Corral GD, Herrera FA. Thrombocytosis is associated with complications after microvascular surgery: an NSQIP data analysis. Microsurgery 2020; 40 (03) 288-297
13 Badawi M, Almazrooa S, Azher F, Alsayes F. Hydroxyurea-induced oral ulceration. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120 (06) e232-e234
14 Stone T, Berger A, Blumberg S. et al. A multidisciplinary team approach to hydroxyurea-associated chronic wound with squamous cell carcinoma. Int Wound J 2012; 9 (03) 324-329
15 Saravu K, Velappan P, Lakshmi N, Shastry BA, Thomas J. Hydroxyurea induced perimalleolar ulcers. J Korean Med Sci 2006; 21 (01) 177-179
16 Bader U, Banyai M, Böni R, Burg G, Hafner J. Leg ulcers in patients with myeloproliferative disorders: disease- or treatment-related?. Dermatology 2000; 200 (01) 45-48
17 Sirieix M-E, Debure C, Baudot N. et al. Leg ulcers and hydroxyurea: forty-one cases. Arch Dermatol 1999; 135 (07) 818-820
18 Lussana F, Cattaneo M, Rambaldi A, Squizzato A. Ruxolitinib-associated infections: a systematic review and meta-analysis. Am J Hematol 2018; 93 (03) 339-347