J Reconstr Microsurg 2010; 26(3): 181-183
DOI: 10.1055/s-0029-1238219
© Thieme Medical Publishers

Thalidomide-Related Vessel Thrombosis in Microsurgical Free Tissue Transfer

Yu-Tzu Tai1 , Pai-Chun Yen2 , Hsin-Han Chen3 , Erh-Kang Chou3
  • 1Department of Dermatology, Chung-Shan Medical University Hospital, Taichung, Taiwan
  • 2Department of Emergency Medicine, Chang-Gung Memorial Hospital, Kaohsiung Medical Center, Chang-Gung University College of Medicine, Kaohsiung, Taiwan
  • 3Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
Further Information

Publication History

Publication Date:
10 November 2009 (online)

ABSTRACT

This article describes a 49-year-old man with lower gum cancer who received tumor ablation by an otolaryngist and immediate reconstruction with microsurgical free tissue transfer. The thrombosis occurred at the arterial anastomotic site at least twice during operation by an experienced microsurgeon and progressed to skin paddle necrosis following surgery. The thalidomide-induced recipient vessel thrombosis is highly suspected after excluding other hypercoagulation problems and technique errors. While thalidomide is increasingly used as an adjuvant therapy agent in head and neck cancer treatment, its potential adverse effect resulting in recipient vessel thrombosis is worth consideration in microsurgery. Prophylatic antithrombosis agents are thus recommended to prevent this potential side effect.

REFERENCES

  • 1 Rajkumar S V, Blood E, Vesole D, Fonseca R, Greipp P R. Eastern Cooperative Oncology Group . Phase III clinical trial of thalidomide plus dexamethasone compared with dexamethasone alone in newly diagnosed multiple myeloma: a clinical trial coordinated by the Eastern Cooperative Oncology Group.  J Clin Oncol. 2006;  24 431-436
  • 2 Kyle R A, Rajkumar S V. Multiple myeloma.  N Engl J Med. 2004;  351 1860-1873
  • 3 Dimopoulos M A, Eleutherakis-Papaiakovou V. Adverse effects of thalidomide administration in patients with neoplastic diseases.  Am J Med. 2004;  117 508-515
  • 4 Rajkumar S V. Thalidomide therapy and deep venous thrombosis in multiple myeloma.  Mayo Clin Proc. 2005;  80 1549-1551
  • 5 Scarpace S L, Hahn T, Roy H et al.. Arterial thrombosis in four patients treated with thalidomide.  Leuk Lymphoma. 2005;  46 239-242
  • 6 Singhal S, Mehta J, Desikan R et al.. Antitumor activity of thalidomide in refractory multiple myeloma.  N Engl J Med. 1999;  341 1565-1571
  • 7 Zangari M, Anaissie E, Barlogie B et al.. Increased risk of deep-vein thrombosis in patients with multiple myeloma receiving thalidomide and chemotherapy.  Blood. 2001;  98 1614-1615
  • 8 Dimopoulos M A, Anagnostopoulos A, Weber D. Treatment of plasma cell dyscrasias with thalidomide and its derivatives.  J Clin Oncol. 2003;  21 4444-4454
  • 9 Eisen T, Boshoff C, Mak I et al.. Continuous low dose thalidomide: a phase II study in advanced melanoma, renal cell, ovarian and breast cancer.  Br J Cancer. 2000;  82 812-817
  • 10 Osman K, Comenzo R, Rajkumar S V. Deep venous thrombosis and thalidomide therapy for multiple myeloma.  N Engl J Med. 2001;  344 1951-1952
  • 11 Zonder J A, Barlogie B, Durie B G, McCoy J, Crowley J, Hussein M A. Thrombotic complications in patients with newly diagnosed multiple myeloma treated with lenalidomide and dexamethasone: benefit of aspirin prophylaxis.  Blood. 2006;  108 403 author reply 404
  • 12 Flageul B, Wallach D, Cavelier-Balloy B, Bachelez H, Carsuzaa F, Dubertret L. [Thalidomide and thrombosis].  Ann Dermatol Venereol. 2000;  127 171-174
  • 13 Bennett C L, Schumock G T, Desai A A et al.. Thalidomide-associated deep vein thrombosis and pulmonary embolism.  Am J Med. 2002;  113 603-606
  • 14 Altintas A, Ayyildiz O, Atay A E, Cil T, Isikdogan A, Muftuoglu E. Thalidomide-associated arterial thrombosis: two case reports.  Ann Acad Med Singapore. 2007;  36 304-306
  • 15 Kaushal V, Kaushal G P, Melkaveri S N, Mehta P. Thalidomide protects endothelial cells from doxorubicin-induced apoptosis but alters cell morphology.  J Thromb Haemost. 2004;  2 327-334
  • 16 Piette J C, Sbai A, Francès C. Warning: thalidomide-related thrombotic risk potentially concerns patients with lupus.  Lupus. 2002;  11 67-70
  • 17 Baz R, Li L, Kottke-Marchant K et al.. The role of aspirin in the prevention of thrombotic complications of thalidomide and anthracycline-based chemotherapy for multiple myeloma.  Mayo Clin Proc. 2005;  80 1568-1574
  • 18 Hirsh J. Risk of thrombosis with lenalidomide and its prevention with aspirin.  Chest. 2007;  131 275-277
  • 19 El Accaoui R N, Shamseddeen W A, Taher A T. Thalidomide and thrombosis. A meta-analysis.  Thromb Haemost. 2007;  97 1031-1036

Erh-Kang ChouM.D. 

Department of Plastic Surgery, China Medical University Hospital

No2, Yu-Der Rd, Taichung, Taiwan (R.O.C.)

Email: erkang27@yahoo.com.tw

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