Upper Extremity Deep Vein Thrombosis and Pulmonary Embolus after Radial Forearm Free Flap: A Case Report and Literature Review

Background

Deep vein thrombosis (DVT) and its associated complications such as pulmonary embolism (PE) are well-known causes of morbidity and mortality in the surgical intensive care unit settings. The presentation, diagnosis, and management of lower extremity DVT (LEDVT) are well documented in the literature. However, the same is not true of those that occur in the upper extremities.[1] Upper extremity DVT (UEDVT) are less common than LEDVT , and usually asymptomatic until their complications arise. Risk factors for UEDVT differ from those of LEDVT, and include presence of a central venous catheter, cancer, and immobility.[1] [2] The first line therapy for UEDVT is systemic anticoagulation with low molecular weight heparin and long-term vitamin K antagonist therapy. Although less than in LEDVT, there is significant morbidity and mortality related to UEDVT, including PE and postthrombotic syndrome. We present a case of UEDVT that occurred in a head and neck cancer patient following relative immobility subsequent to radial forearm free flap harvest from his left arm.

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