We report two cases of central venous catheter-related deep venous thrombosis (DVT) that occurred after oral cancer resection and reconstruction with vascularized free flap. In addition, we present a manual on coping with DVT which has been used by dentists in the Hokkaido University Hospital since July 2014.
First case: A 60-year-old man with oral floor cancer (cT4aN1M0) underwent tumor resection, neck dissection, and reconstruction with anterolateral thigh flap in May 2010. At the time of administration of general anesthesia, a central venous catheter (CVC) was inserted through the femoral vein and it was removed five days after the operation. In April, prior to the operation, early gastric cancer was detected endoscopically. Three months after the operation, enhanced CT was performed before endoscopic submucosal dissection for the gastric cancer. A 7-cm thrombus was detected in the inferior vena cava, which was diagnosed as deep venous thrombosis (DVT). Warfarin was administered as an anticoagulant. Two weeks later, the size of the thrombus decreased, and it disappeared after two more months of warfarin therapy.
Second case: A 69-year-old woman with tongue cancer (cT2N0M0) underwent tongue resection, neck dissection, and reconstruction with anterolateral thigh flap in February 2014. At the time of administration of general anesthesia, a CVC was inserted through the femoral vein; it was removed seven days after the operation. Drug-induced hepatopathy related to prostaglandin E1 occurred one week after the operation. Ultrasonography revealed DVT. Heparin was immediately administered intravenously as an anticoagulant. The thrombus disappeared after heparin therapy for a week.